Glisson Traction Research Articles

Comparison of Glisson traction, soft or rigid cervical collars for the treatment of acute atlantoaxial rotatory subluxation in children: a retrospective study

To examine the clinical effect of different conservative therapies (Glisson traction, soft and rigid cervical collar) in the treatment of children with acute atlantoaxial rotatory subluxation. One hundred and forty-four children with acute atlantoaxial rotatory subluxation treated conservatively at our hospital from June 2017 to June 2022 were retrospectively analyzed. The children were divided into three groups consisting of patients treated with Glisson traction (n = 37), patients treated with soft cervical collar (n = 55), and patients treated with rigid cervical collar (n = 52). Clinical and functional results were compared among the three groups. Success outcomes were achieved at the end of treatment in the Glisson traction group (94.59%, 35/37), soft cervical collar group (83.64%, 46/55), and rigid cervical collar group (92.31%, 48/52). There was no significant difference between the success rates among the three groups (P > 0.05). At the last follow-up, the overall scores based on our scoring scale for the Glisson traction, soft cervical collar and rigid cervical collar groups were 95.95 ± 6.11 (range: 75–100), 94.64 ± 6.30 (range: 75–100) and 95.00 ± 6.02 (range: 70–100), respectively. There was no significant difference in the overall scores among the three groups (P > 0.05). All three conservative therapies for the treatment of acute atlantoaxial rotatory subluxation can attain a good clinical outcome. Treatment using a cervical collar should be given priority as it does not require the child to be hospitalized. Rigid cervical collar provides good immobilization and can possibly lead to better clinical outcomes compared to a soft cervical collar.

Primary treatment of atlantoaxial rotatory fixation in children: a multicenter, retrospective series of 125 cases.

The primary treatment for atlantoaxial rotatory fixation (AARF) remains controversial. The aim of this study was to investigate the primary treatment for AARF and create an algorithm for primary treatment. The authors analyzed the data of 125 pediatric patients at four medical institutions from April 1989 to December 2018. The patients were reported to have neck pain, torticollis, and restricted neck range of motion and were diagnosed according to the Fielding classification as type I or II. As a primary treatment, 88 patients received neck collar fixation, and 28 of these patients did not show symptom relief and required Glisson traction. Thirty-seven patients were primarily treated with Glisson traction. In total, 65 patients, including neck collar treatment failure patients, underwent Glisson traction in hospitals. The success rate of treatment was significantly higher in the Glisson traction group (97.3%) than in the neck collar fixation group (68.2%) (p = 0.0001, Wilcoxon test). In the neck collar effective group, Fielding type I was more predominant (p = 0.0002, Wilcoxon test) and the duration from onset to the first visit was shorter (p = 0.02, Wilcoxon test) than that in the neck collar ineffective group. Using multivariate logistic regression analysis with the above items, the authors generalized from the estimated formula: logit [p(success group by neck collar fixation group)|duration from onset to the first visit (x1), Fielding type (x2)] = 0.4(intercept) - 0.15x1 + 1.06x2, where x1 is the number of days and x2 = 1 (for Fielding type I) or -1 (for Fielding type II). In cases for which the score is a positive value, the neck collar should be chosen. Conversely, in cases for which the score is a negative value, Glisson traction should be the first choice. According to this formula, in patients with Fielding type I AARF, neck collar fixation should be allowed only if the duration from onset is ≤ 10 days. In patients with Fielding type II, because the score would be a negative value, Glisson traction should be performed as the primary treatment.

Conservative therapy for atlantoaxial rotatory fixation with long-term Glisson traction

Conservative therapy for atlantoaxial rotatory fixation with long-term Glisson traction

Une fracture-luxation antérieure de C3 chez un enfant révélée par un syndrome de Claude Bernard–Horner

Injury of the cervical vertebrae in children is very rare, and few cases of dislocation-fracture in the cervical vertebrae below C3 have been reported. We experienced a child case who had a very rare C3/4 flexion-distraction type spinal injury accompanying C5 level spinal cord injury and Horner’s syndrome caused by sympathetic trunk palsy. The patient was a 5-year-old boy. The boy was thrown head first from the backseat of a car in a traffic accident, pinning the neck between the broken window and guardrail. The patient, with an 8 cm long injury to the left upper clavicle region, was transported to a medical emergency center, and referred to our hospital after initial treatment. At the first examination, torticollis with neck pain and limitation of left palpebral opening were observed. The strength of bilateral muscles in the upper limbs was grade 1/5 muscle weakness in the deltoid muscles, 3/5 in the biceps, and 4/5 in others. The injury was diagnosed as a C3 anterior dislocation-fracture by plain radiography and computed tomography. The dislocation was reduced by glisson traction, but the operation of posterior cervical fixation (C3/4 spinous process wiring) was needed because it was difficult to maintain the reduced position using a fixation device. The postoperative course was good, and bony union was obtained. The strength of muscles in the upper limbs improved to 3/5 in the deltoid muscles, 4/5 in the biceps, and 5/5 in others, and Horner’s syndrome also improved.

咽頭弁形成術後に環軸椎回旋位固定を生じた２２ｑ１１欠失症候群患者の１例

We describe an 8-year girl with atlanto-axial rotatory fixation (AARF) caused accidentally after pharyngeal flap plasty under general anesthesia. On the third postoperative day, she had torticollis without neurologic damage and complained of neck pain when she rotated her head. AARF was diagnosed on the basis of the computed tomographic findings. Glisson traction with 1.5 kilograms of weight for 2 weeks reduced the dislocation, but further treatment was reguired. The deformity was corrected by manipulation under general anesthesia and the patient's head and neck were immoblilized in a Minerva jacket for 6 weeks. A cervical collar was used subsequently in an attempt to maintain normal spinal alignment, and the reduction remained.AARF is a rare disorder caused by a variety of conditions. Diagnosis is often difficult and delayed. During operation, hyperextension of the neck should be avoided. It is important to be aware of AARF and to begin treatment as soon as possible in patients with postoperative manifestations such as head tilt, neck pain, and inability to rotate the head.

環軸椎回旋位固定の治療経験

We report three cases of atlanto-axial rotatory fixation (AARF). Two of the cases were secondary to plastic surgeries of microtia, and the third case took a month to be diagnosed as AARF and was difficult to cure. In all cases, we selected conservative therapy including manipulative reduction under general anesthesia. First, we attempted to treat AARF with fixation by neck braces. If remarkable recovery from neck pain or in range of motion of the neck was not achieved, continuous traction (Glisson's traction) was started. If symptoms still continued for about two weeks, manipulative reduction under general anesthesia followed by skeletal traction was chosen. The first two cases were cured in this way. In case 3, recurrence was observed after manipulative reduction, so we repeated manipulation. All the cases finally achieved sufficient recovery from AARF only by conservative therapy.

強直性脊椎炎に合併した頚椎骨折の稀な一例

This is a case report of cervical fracture associated with ankylosing spondylitis.The patient was a 52-year-old man with a 20-year-history of ankylosing spondylitis who presented with a cervical fracture after falling down on the ground. Plain X-ray film showed the fracture to be at the C6/7 disk level although he suffered from only mild myelopathy.After Glisson traction, the angular deformity at at the fracture site was repositioned and anterior spinal fusion was performed.After the operation, the patient's neurological symptoms resolved. Post-operatively he started sitting up in bed in propped up position using a SOMI brace.It was believed that this case escaped complete spinal cord injury and maintained an intact spinal canal.

The "tear drop" (or avulsed) fracture of the anterior inferior angle of the axis.

Fourteen cases of an anterior inferior angle fracture of the axis treated in the Orthopaedic Department of the University of Athens from January 1970 to December 1992 were analysed. The mean follow-up time was 8.5 years. The so-called "tear drop" fracture of the axis composes a special entity characterised by an avulsed fragment, of varying size, from the anterior inferior angle of the body of the axis as a result of hyperextension. This type of injury is not a frequent one, representing 3% of the cervical spine trauma in our Department. There were eight men and six women with a mean age of 47 years. Road traffic accident is by far the most common mode of aetiology. The stability of this lesion is questioned by certain authors, resulting in disagreement concerning the choice of treatment to be followed. All the patients in our series were treated conservatively, consisting at the beginning with Glisson traction and then the use of a simple cervical collar. The rotation of the detached fragment, its anterior displacement, the posterior displacement of the vertebral body as well as the presence of instability at the C1-3 levels were analysed. The high incidence of co-existing lesions at the same or at a more distal level is discussed. This study revealed that there was no significant displacement of the vertebral body, and thus disturbance of the posterior ligaments, rendering the fracture stable.(ABSTRACT TRUNCATED AT 250 WORDS)

小児の頚椎椎間板石灰化症の一例

A case of calcification of cervical disc in children is reported this time. The patient is a 5-year-old boy, complaining of neck pain and limited neck motion. Calcification at C 4/5 disc level is found on X-ray. We treated with analgesic and anti-inflammatory agent and glisson traction. After 2 weeks the clinical symtom was recovered. Ten months later, calcification was almost decreased.