Overview
This lecture discusses protocols, benefits, risks, and practical considerations for performing cervical traction, especially in awake patients, and debates MRI timing in relation to the procedure.
Cervical Traction Benefits
- Awake patients allow instant neurological assessment during traction, enabling quick reversal if deficits occur.
- Cervical traction can be performed faster at the bedside compared to operating room procedures.
- Immediate decompression of the spinal cord is possible, with definitive stabilization performed later.
Risks and Contraindications
- There is a risk of worsening neurological injury by displacing disc material during reduction.
- Closed reduction is contraindicated if a large disc herniation is seen on pre-traction MRI.
- Skull fractures must be ruled out before applying skull pins.
MRI Timing Debate
- Pre-traction MRI may reveal disc herniations that could be worsened by traction, influencing the decision to proceed.
- Post-traction MRI is often preferred to assess for new disc herniations after the reduction.
- Patient neurological exam during awake procedures may be more informative than MRI before traction.
Cervical Traction Protocol
- Rule out skull fractures before placing traction pins to avoid intracranial injury.
- When placing halo pins, have the patient’s eyes closed to prevent pinning the eyelids open.
- Choose traction direction (flexion or extension) based on fracture type and anatomical goals.
- Place traction pins relative to the external auditory meatus for desired neck movement.
- Start with low weights and obtain initial X-ray to check for atlanto-occipital dislocation.
- Increase weights gradually, obtaining X-rays after each increase, with X-ray equipment kept in the room.
- Stop traction if distraction at craniovertebral junction occurs, disc height exceeds 10 mm, or new neurological deficits appear.
- Leave the patient in traction until definitive surgical stabilization can be performed.
Key Terms & Definitions
- Cervical Traction — A method to realign cervical spine fractures or dislocations by applying controlled force via pins or halo.
- Closed Reduction — Non-surgical realignment of fractured bones or joints.
- Atlanto-Occipital Dislocation — Abnormal separation between skull and first cervical vertebra.
- External Auditory Meatus — Ear canal opening, used as a landmark for pin placement.
- Halo — External fixation device for immobilizing the cervical spine.
- Axial Traction — Force applied along the axis of the spine to achieve reduction.
Action Items / Next Steps
- Review cervical traction protocols and indications.
- Study anatomy relevant to pin placement and traction directions.
- Understand when to order MRI in relation to cervical traction.