Initial Closed Reduction of Cervical Spinal Fracture-Dislocation Injuries

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.