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Closed skeletal traction for unilateral locked facet can expedite realignment but does not affect time to decompression or AIS grade conversion at long-term follow-up

Wednesday, February 21, 2024

Presenting Author(s)

Bradley Wilhelmy, MD (he/him/his)

Medical Student
University of Maryland Medical Center
Baltimore, MD, US

Co-Author(s)

Bizhan Aarabi, MD

Professor
University of Maryland Medical Center
Baltimore, MD, US
CC

Chixiang Chen, PhD

Assistant Professor
University of Maryland School of Medicine, United States
Timothy Chryssikos, MD, PhD

Attending Physician
University of Maryland Medical Center
Baltimore, Maryland, United States
Kenneth M. Crandall, MD

Attending Physician
University of Maryland Medical Center
Baltimore, MD, US
CL

Cara Lomangino

Nurse Practitioner
University of Maryland Medical Center, United States
Joshua Olexa, MD

Resident Physician
University of Maryland Medical Center
Baltimore, Maryland, United States
PP

Parantap Patel, MD

Resident Physician
University of Maryland Medical Center
Baltimore, Maryland, United States
Charles Sansur, MD, MHSc

Attending Physician
University of Maryland Medical Center
Baltimore, Maryland, United States
MS

Maureen Scarboro

Nurse Practitioner
University of Maryland Medical Center, United States
Gary Schwartzbauer, MD, PhD

Professor
University of Maryland Medical Center
Baltimore, Maryland, United States
Jesse A. Stokum, MD, PhD (he/him/his)

Resident
University of Maryland School of Medicine
Baltimore, MD, US

Introduction: Closed skeletal traction (CST) for unilateral locked cervical facet (ULCF) is often attempted prior to surgery with variable success. The relationships between CST success with time from injury to surgery and postoperative MRI and with neurological outcome are not known.

Methods: Demographic, radiographic, and surgical data were analyzed from patients presenting with ULCF at a single Level I Trauma Center.

Results: Forty-six patients with ULCF had attempted CST before surgery. Mean age was 45.6±17.7, 34 patients (72.3%) were male, and C6-7 was the most common level of injury. Median admission ASIA motor score was 39. Twenty-six patients (55.3%) had a successful CST (mean weight 59.8±33.5lbs). Forty-three patients (91.5%) had fractures and 15 had epidural hematoma (31.9%). Seven cases (14.9%) had diffuse idiopathic skeletal hyperostosis (DISH). Patients who were successfully reduced with CST achieved realignment sooner (5.5±3.5 hours after arrival vs. 13.3±8.0 hours for unsuccessful CST requiring open reduction, p = 0.0023). Fractures involving the superior vertebral body of the locked level (OR=0.054, p=0.014) and DISH (OR=0.116, p=0.050) reduced the odds of successful CST. AIS grade A (OR=5.630, p=0.059) and contralateral perched facet (OR=15.967, p=0.052) trended towards increased odds of successful CST. There was no association between CST outcome and time interval from injury to surgery (p = 0.752) or time interval from injury to verification of spinal cord decompression with postoperative MRI (p=0.303). In patients with minimum three months follow-up there was no significant difference in AIS grade improvement with successful CST (AIS Grade E was excluded from this analysis). Successful CST trended towards improved ASIA motor score (27.43 vs 11.82, p=0.067).

Conclusion : Morphological and clinical variables may help predict successful CST. Successful CST was associated with shorter time to reduction, but was not associated with shorter time to surgery, postoperative MRI, or AIS grade improvement at minimum three months.