In acute cervical spine trauma, skull traction is used to reduce a dislocation or fracture dislocation, to immobilize an unstable lesion until definitive treatment (operative or conservative) is possible or, more rarely, as a definitive treatment until healing occurs.

More commonly employed in the US.

Initial weight (in lbs) = 3 cervical vertebral level increase in 5-10 lb increments usually at 10-15 minute intervals until the desired alignement is attained.

Practice guideline: Initial closed reduction in fracture-dislocation cervical SCI

Level III 1) 2)

● early closed reduction of C-spine fracture-dislocation injuries with craniocervical traction to restore anatomic alignment in awake patients

● ✖ not recommended: closed reduction in patients with an additional rostral injury

● patients with C-spine fracture-dislocation who cannot be examined during attempted closed reduction, or before open posterior reduction, should undergo cervical MRI before attempted reduction. The presence of a significant herniated disc in this setting is a relative indication for anterior decompression (e.g. by an anterior cervical discectomy and fusion) before reduction

● cervical MRI is also recommended for patients who fail attempts at closed reduction

see also Cervical traction for cervical disc herniation.

1)
Section on Disorders of the Spine and Peripheral Nerves of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons. Initial closed reduction of cervical spine fracture-dislocation injuries. Neurosurgery. 2002; 50 Supplement:S44–S50
2)
Gelb DE, Aarabi B, Dhall SS, et al. Treatment of sub- axial cervical spinal injuries. Neurosurgery. 2013; 72 Suppl 2:187–194