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Traumatic injuries to the cervical spine result from forces acting on the head and neck. The incidence of spinal cord injury in the United States is approximately 5 per 100,000 population.1 Approximately 60% to 80% of spinal cord injuries involve the cervical spine. Motor vehicle collisions are the most common cause and account for almost half of the cervical spine injuries.2 The remaining cervical spine injuries result from falls, sports injuries, violence, penetrating wounds, and miscellaneous causes.
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The primary aims of therapy in the treatment of the patient with an acute spinal cord injury are to minimize secondary injury to the spinal cord, to realign the spine, to improve neurological recovery, to maintain spinal stability, and to obtain an early functional recovery. This is achieved by decompression of the spinal cord by restoring the normal sagittal diameter of the spinal canal or by removing a compressive lesion surgically. This is particularly important in patients who have sustained an incomplete spinal cord lesion and are found to have a progressing neurological deficit. Restoring the normal anatomic position also provides for pain relief.
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Early operative intervention can be performed for the treatment of acute cervical fractures to achieve decompression and restore normal alignment. The use of skeletal traction in the acute spinal cord injury patient remains a very safe and straightforward method of reducing fractures and maintaining the spinal canal in anatomical alignment.
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Fabricius Hildanus utilized forceps in treating fractures or dislocations of the cervical spine as early as 1646. Crutchfield developed a pair of self-tightening tongs in 1933 that allowed him to apply traction to the cranium in a patient with a cervical spine fracture.3 These tongs were subsequently modified and have essentially been replaced by the Gardner-Wells tongs.4
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Cervical spinal cord injuries can be divided into upper (occiput to C3) and lower (C3 to C7) injuries. Numerous classification systems exist. These are based upon the morphology and the mechanism of injury.5 No classification is ideal. However, critical to all cervical classifications is the determination of stability of a fracture or dislocation. Stability of the vertebral column is dependent upon the integrity of the vertebra, the intervertebral disk, the facet joints, and most importantly the ligamentous structures.
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Clinical stability of the cervical spine is determined by the ability of the spine under physiological loads to maintain its normal anatomical relationship so that there is no damage to the spinal cord or nerve roots. It has been proposed that spinal instability be separated into mechanical, neurologic, and combined types. Mechanical instability implies that the injured spine could collapse or distort under normal physiological stresses. Neurological instability implies a risk of neural injury (spinal cord and/or nerve root) subsequent to the initial injury.
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It is exigent that a thorough clinical and radiological evaluation be completed to determine if the patient has suffered an unstable cervical spine injury....