Cervical Spine Dislocation

 

C5 displacement over C6 , (displacement > 50 % , it's a Bifacet dislocation )

Delayed Diagnosis of B/l facet dislocation :a case report.Julie O Shaughnessy et. al.

Only shows C7 and is inadequate for trauma C-spine lateral radiograph. 

Management 

    - ATLS guideline -remove helmet visor to gain access to eyes , nose and mouth.

    - Exclude other injuries.

    - Full imaging of spine / full neurological examination - ensure this is isolated injury.    

    - Spine surgery consultation for reduction 

                    Close or Open 

    - Exclude a prolapsed disc which damages cord during reduction.

    

         If no MRI scanner, can we reduce with patient awake ?

        Yes, we can reduce. We can monitor patient awake, alert .Serial neurological examination is also             possible.

         Gardner-Wells-Tong / Crutchfield skull traction is applied on skull and then adding sequential                 weights to traction cord.

        Patient positioned on supine, under C-arm guidance, after each addition of weight load, image                 taken and assessed. Initially 10 pounds then 5 pounds added. Once neck is fully stretched, facets             unlocked then neck is fully extended to complete the reduction and traction reduced. 

        How do we apply a Halo traction Jacket?

        Take the consent.

        Four pins using local anaesthesia applied on skull, tightened with a torque limiter (6 pins for                     children)

        Placement carried out as follows - 

         1. Anterior - 1 cm above lateral outer 1/3rd of eyebrow

         2. Posterior - Behind earlobe above mastoid 

        Three Person Job- one holding head and two applying Halo.

        Apply Jacket of approximate size.

        Check radiograph of spine to ensure correct reduction.

        Tighten pins after 24 hours. 

    https://www.slideserve.com/taber/critical-          care-of-spinal-cord-injury-dr-amr-el-said-       professor-of-anaesthesia-intensive-care-      faculty-     of-medicine.

  Complications 

        Loss of reduction 

        Pin site infection and Loosening 

        Pain

        Nerve Injury