Efficacy of Closed Reduction with Craniocervical Traction for Acute Traumatic Cervical Fracture Subluxation Injury

Introduction: Acute traumatic cervical subluxation with jumped or perched facets is a highly unstable injury that can result in severe neurological deficits. While the 2013 CNS Guidelines1 recommends closed reduction with craniocervical traction, recent reports favor surgical open reduction. This study aims to assess the efficacy of closed reduction at a high-volume academic medical center.

Methods: A retrospective review identified patients treated for traumatic cervical fracture subluxation between 2015 and 2023. Data on closed reduction attempts, success rates, and time to decompression were collected from patient charts and imaging. Time at which decompression was achieved was defined as either the time when closed reduction was achieved or the surgical start time for open reduction. Closed reduction success rates and time to decompression were compared using the Wilcoxon Rank-Sum test.

Results: Of 53 patients, 43 underwent attempted closed reduction, with 29 achieving successful reduction (67.4%) and 5 achieving partial reduction (11.6%). The mean time to decompression for patients with successful closed reduction was 13 hours and 15 minutes, while it was 22 hours and 31 minutes for unsuccessful attempts. For patients requiring open reduction, the mean time to decompression was 25 hours and 58 minutes. One patient developed worsening neurological deficits during closed reduction attempts.

Conclusion : Closed reduction with craniocervical traction remains a viable early management strategy for cervical fracture subluxation, demonstrating high success rates and minimal complications. Importantly, unsuccessful closed reduction attempts do not significantly delay spinal decompression.