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Urgent closed reduction of the dislocated cervical spine in New Zealand
Author(s) -
Storey Richard N.,
Singhal Raj,
Inglis Tom,
Kieser David,
Schouten Rowan
Publication year - 2017
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.14231
Subject(s) - medicine , guideline , reduction (mathematics) , cervical spine , decompression , spinal cord injury , spinal cord , traction (geology) , surgery , geometry , mathematics , pathology , geomorphology , psychiatry , geology
Background Emergent decompression, either by closed reduction or surgical decompression, of the acutely compressed cervical spinal cord is recognized as important in minimizing the neurological outcomes of these injuries. The aim of this study is to optimize New Zealand's capability to perform closed reductions. Methods Regional hospitals throughout New Zealand were surveyed on their capability to reduce acute cervical spine dislocations using traction. A systematic literature review was performed to investigate aspects of patient selection, reduction technique and the outcomes achieved with closed reduction of such injuries. This information was combined with our local experience to develop an evidence‐based guideline. Results Most (12/14) of the regional centres throughout New Zealand have recent experience, remain willing and have the resources necessary to reduce appropriate cervical spine injuries using traction. Fourteen published studies from nine countries detail a 75% success rate from 363 cases of attempted closed reduction, with the greatest neurological recovery noted in patients with shorter time period from injury to reduction. One patient suffered neurological worsening. The published protocols were compared and coupled with our local practice to create an online, step‐by‐step, evidence‐based reference to help clinicians in regional hospitals perform a safe and successful closed reduction. Conclusion To optimize the capability of inexperienced personnel to perform closed reductions in a safe and timely manner, we have developed an online, step‐by‐step, evidence‐based reference ( www.closedreduction.co.nz ). This forms part of New Zealand's strategy to achieve urgent cord decompression for appropriate cervical spinal cord injuries.