- Hard collar if possible.
- Do not force into a collar if spine is locked.
- Instead use sandbags, towel rolls, and tape.
Closed reduction by spine specialist (often in the ED):
- Halo device
- Gardner-Wells tongs. This involves placing a traction device into the skull and increasing hanging weights at 15 minute intervals until serial radiographs document reduction.
- Neurologic deficit may worsen after closed reduction (from disc protrusion), so serial neurologic exams are crucial.
These injuries are usually subsequently managed operatively.