Initial Closed Reduction of Cervical Spinal Fracture-Dislocation Injuries

Publication Date: November 30, 2013
Last Updated: March 14, 2022


Level III

Early closed reduction of cervical spinal fracture/dislocation injuries with craniocervical traction for the restoration of anatomic alignment of the cervical spine in awake patients is recommended.
Closed reduction in patients with an additional rostral injury is not recommended.
Magnetic resonance imaging is recommended for patients with cervical spinal fracture dislocation injuries if they cannot be examined during closed reduction because of altered mental status or before either anterior or posterior surgical procedures when closed reduction has failed. Prereduction magnetic resonance imaging performed in patients with cervical fracture dislocation injuries will demonstrate disrupted or herniated intervertebral disks in one-third to one-half of patients with facet subluxation injuries. These findings do not appear to influence outcome following closed reduction in awake patients, and therefore, the utility of prereduction MRI in this circumstance is uncertain.

Recommendation Grading




Initial Closed Reduction of Cervical Spinal Fracture-Dislocation Injuries

Authoring Organization

Publication Month/Year

November 30, 2013

Last Updated Month/Year

June 26, 2023

Document Type


External Publication Status


Country of Publication


Document Objectives

The purpose of this qualitative review is to address the following issues:

  1. Is closed reduction safe and effective for reducing cervical spine deformity in patients with cervical fractures or unilateral or bilateral facet dislocation injuries?

  2. Is a prereduction MRI study essential for managing these patients?

Target Patient Population

Patients with spinal cord injuries

Inclusion Criteria

Female, Male, Adolescent, Adult, Older adult

Health Care Settings

Ambulatory, Emergency care, Hospital, Outpatient

Intended Users

Nurse, nurse practitioner, physician, physician assistant


Assessment and screening, Management

Diseases/Conditions (MeSH)

D013116 - Spinal Cord, D013119 - Spinal Cord Injuries, D066193 - Cervical Cord, D000072039 - Fracture Dislocation, D007403 - Intervertebral Disc, D008279 - Magnetic Resonance Imaging


magnetic resonance imaging (MRI), fracture dislocation, spinal cord

Source Citation

Neurosurgery, Volume 72, Issue suppl_3, March 2013, Pages 73–83,