PROF. A SATTAR M HASHIM.DEPT. OF NEUROSURGERY

JPMC KARACHI

Cervical Traction

Cervical Traction

Cervical traction creates a longitudinal pull along the cervical spine that reduces deformity, restores normal anatomic alignment, and provides stabilisation.

Indications

1. Temporary stabilisation to preserve neurological function in trauma patients.

2. Pre operative reduction in patients with deformity or displaced fractures.

3. Intraoperative Stabilisation and interspace distraction for anterior grafting.

4. Pain relief for patients with radiculopathy or muscle spasm.

There are three methods of applying cervical traction:

The Head Halter.Cervical Tongs.Halo Head Ring.

Historical Background.

Halter traction was first employed in 1929 by A.S.Taylor to reduce a cervical fracture before immobilisation in a plaster cast.

Crutchfield 1933

The introduction of tongs for skeletal traction to treat a cervical fracture dislocation is attributed to Crutchfield.(1933).

The original patient had a mandibular fracture that prevented Crutchfield to use halter traction.

Original tongs used by Crutchfield in 1933 to reduce a cervical fracture.

Crutchfield tongs had blunted tips that require burr holes for placement.

There unique position and small size allow the patient to be turned in bed with relative ease.

Their main disadvantage are the time required for tong placement and their vertex position which makes them easy to dislodge.

In 1973, Gardner introduced the easily applied tongs that are most commonly used type of tongs today.

Gardner- Wells Tongs.

Application of Gardner-Wells Tongs.

These tongs are easily applied under local anesthesia.

Pin location is just below the equator of the skull and just above the ears in line with the E.A.M and mastoid process.

Hairs are not usually shaved.The pins are placed over the appropriate scalp

position and are tightened simultaneously by hand until the tension indicator on the spring-loaded pin protrudes 1mm.

After the tongs are set, traction is applied by attaching a traction line through the eye at the top of the tongs.

This line is taken through a pulley situated at the top of the bed and then attached to the weights.

To prevent the patient from sliding up the bed, counter traction is applied by elevating the head of the bed (20-30 degrees) before adding the weights for traction.

The final step in application is obtaining x-ray films of the skull and cervical spine to ascertain the position of the tongs and alignment of the spine.

Additional lateral films of the cervical spine will be required after each application of additional weight.

The pins are normally retightened 24 h after initial application.

Pin site care is essential to avoid local skin infection.

Precautions

Great care must be taken when applying the tongs so that excessive manipulation of the cervical spine does not occur.

Neurological assessment must be carried out after each increase in traction weight to avoid neurologic worsening.

How much weight to use for traction?

Debate exists in literature over the amount of weight required for reduction of a fracture-dislocation and the maximum weight that should be used.

Crutchfield developed a rule of 5 lb. Per cervical level starting with 10 lb. for the head.

A C1-C2 injury would therefore be allowed a max of 15 ib. and a C5-C6 injury would be allowed up to 35lb.

How much weight to use for traction?

It is generally accepted practice to add weight in 5-lb increments until reduction is achieved or to a maximum of 70 lb.

once reduction is achieved the spine is extended and weight reduced to 5 or 10 lb.

How much weight to use for traction?

Traction should be commenced at 10-15 lbs.Marked distraction may occur if weights of

more than 15 lb. are used initially in presence of ligamentous injury.

Analgesics and muscle relaxants are often required to help overcome the forces generated by the cervical musculature.

Radiographic Monitering

Gradual reduction of bilateral dislocated cervical facets using Gardner-Wells Traction.