Skull traction for cervical spinal injury in Enugu: A 5‑year retrospective multicenter analysis of the clinical outcomes of patients treated with two common devices

Abstract

Background: Treatment of cervical spine injury is the most challenging of all the injuries of the spine, and there is yet no agreement on the best method of care.

Objective: We studied the complications and outcome of two skull traction devices used to treat cases of cervical spine injury in three centers in Enugu, South East Nigeria.

Patients and Methods: A retrospective analysis of patients with cervical spine injury managed with skull traction as the definitive treatment using either Crutchfield or Gardner‑Wells tongs over a 5‑year period (April 2008–March 2013). The traction was applied for 6 weeks, and the patient was subsequently mobilized with either hard cervical collar or Minerva jacket for another 6 weeks.

Results: One hundred and five patients with complete records out of 127 cervical spinal injured patients treated were studied. Forty‑one had the American Spinal Injury Association (ASIA) Grade A whereas 64 had incomplete cord injury of ASIA Grades B–E. Forty‑eight had Crutchfield traction whereas 57 had Gardner‑Wells traction. At the end of treatment, no patient improved among those with ASIA Grades A and B. All the 12 cases of mortality were recorded as well among ASIA A (n = 9) and B (n = 3) Grades. Over 50% of ASIA Grades C and D patients improved to Grade E. The complication profile varied significantly between the traction subgroups with those treated using Crutchfield tongs experiencing more events (χ² = 6.5, df = 1, P < 0.05). However, there was no significant statistical difference in the Association Impairment Scale (AIS) outcome (P = 0.55) as well as mortality rates (χ² = 0.97, DF = 1, P > 0.05) between those treated with Crutchfield and Gardner‑Well traction.

Conclusion: Crutch field tong traction may be associated with more complications when compared with Gardner‑Wells traction. However, from our study, the final American Spinal Injury AIS outcome, as well as the overall mortality rates associated with the two traction techniques, did not vary significantly.

Keywords: Cervical spine injury, conservative treatment, outcome, skull traction