RESUMO
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.