Principles of treatment

1. Traction. The cervical spine can be stabilized using Gardner-Wells tongs and 5 kg of traction. After application, a lateral film should be obtained and neurological observations undertaken. Closed reduction should be attempted in all patients with malalignment. Reduction is performed under close radiological and neurological observation, after each weight addition. The initial weight is 10 kg, with 2.5 kg increments. A maximum weight of 30 kg is applied for the lower cervical spine and 10 kg for CI and C2. Traction should be discontinued in the presence of:

• Neurological deterioration.

After reduction, the traction is reduced to 10 kg or less, to maintain alignment.

2. Surgery. Timing is the major issue in surgery. Many authors consider that maximal damage occurs at the time of injury. However, there is evidence in dogs that decompression at 1 hour post-injury gives a better neurological outcome. Other studies also show that neurological deterioration is more common in patients operated on within 5 days than in patients who are operated on later. Thus the emphasis should be on resuscitation, closed immobilization and restoration of alignment. There is agreement that neurological deterioration in the presence of canal compromise is an indication for emergency surgery. Conversely, neurological deterioration without canal compromise is a contraindication to surgery.

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