Cervical traction is set up after the induction of anesthesia. The weights applied for traction are approximately 5 kg or one-sixth of the total body weight. The patient is placed prone with the head end of the table elevated to about 35 degrees . Cervical traction stabilizes the head in an optimally reduced extension position and prevents any rotation. The traction also ensures that the weight of the head is directed superiorly toward the direction of the traction and pressure over the face or eyeball by the headrest is avoided. The head is in a “floating” position, with the headrest being placed only for additional or minimal support and to prevent unwanted head rotation. Elevation of the head end of the table, which acts as a counter traction, helps to reduce venous engorgement in the operative field.
Indications
Cervical traction has been used in a variety of cervical pathologies:
- Cervical disc disease
- Cervical spine fracture
- Facet joint dislocation
- Atlantoaxial subluxation
- Occipitocervical synopsis
- Spondylosis
- Radiculopathy
- Foraminal Stenosis
- Myofascial tightness
Contraindications
There are no scientific reports that accurately describe the contraindications and relative contraindications for cervical traction. Probable contraindications and/or relative contraindications to cervical or lumbar traction include the following:
- Acute torticollis
- Aortic Aneurysm
- Active peptic ulcer disease
- Diskitis
- Old age
- Osteomyelitis
- Osteoporosis
- Ligamentous instability
- Primary or metastatic tumor
- Spinal cord tumor
- Myelopathy
- Pregnancy
- Severe anxiety
- Untreated hypertension
- Vertebral-basilar artery insufficiency
- Midline herniated nucleus pulposus
- Restrictive lung disease
- Hernia
Preparation
The patient’s vital signs should be monitored before and immediately following the application of cervical traction in all high-risk patients, especially in those with high blood pressure or cardiac problems. It is important to obtain a detailed history and perform a systematic physical exam, before cervical traction, to rule out any contraindications.
Technique
There are different ways to apply cervical traction to the cervical neck. [8][9][10][11][9]
Manual Cervical Traction
Manual traction is mainly for diagnostic purposes, with the ability to confirm a suspected diagnosis after successful relief of symptoms.
- The head and neck are held in the hands of the practitioner, and then a gentle traction of a pulling force is applied.
- Intermittent periods of traction can be applied, holding each position for about 10 seconds.
It also allows the performer to apply controlled pressure on pressure points, which helps alleviate the patient’s pain. Ideally, it is done at a 20-degree angle of flexion, but the examiner must explore all angles, including the extension of the neck and chin rotation, with a thorough assessment of each position.
Mechanical Cervical Traction
Mechanical traction includes pinning, with the placement of a Halo device around the head; where anterior pins are placed 1 cm above each of the eyebrows, and two posterior pins are placed on the opposite end of the skull. The addition of pins can be essential if further stabilization is required.
- A harness attaches to the head and neck of the patient while he is laying down on his/her back.
- The harness is itself attached to a machine that applies a traction force, which can be regulated through a control panel.
Other shorter-term traction devices comprise the Gardner-Wells tongs, which constitute of two pins, pointing upward (towards the vertex of the head), to be placed below the temporal ridge, bilaterally. In both cases, careful pinning is to be applied with a torque pressure of 2 lb to 4 lb in the pediatric population, and up to 8 lb in adults.
Mechanical traction requires a 0-degree angle pull for C1 and C2 pathologies, and a 20-degree angle flexion for below C2 cases. Moreover, the force applied during pull tension must not exceed 10 lb in cases of C1-C2 subluxation, but can otherwise increase up to 45 lb. Some practices require a gradual increase of the pull tension, while others prefer choosing the lowest weight inciting an effective response.
Over-the-Door Traction
This is a more practical way of applying cervical traction, that is more accessible to outpatient practices.
- Over-the-door traction entails strapping a harness to the head and neck of the patient that is in a seated position.
- The harness is connected to a rope in a pulley system over a door. The force is applied using weights (a sandbar or a waterbag) attached to the other end of the rope.
