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QUESTION 1 OF 1

A 42-year-old motor cyclist comes off her bike. She has sustained a flexion distraction injury to her cervical spine leading to a bilateral facet dislocation at level C5-6. On further assessment she is found to have decreased sensation over her left thumb and decreased power with left wrist extension. Her other injuries include a small hemopneumothorax with anterior 5th to 10th rib fractures, successfully treated with a chest drain. Her GCS is currently 15.
After ATLS assessment and adequate resuscitation an MRI of the cervical spine demonstrates a large disc herniation at level C5-6.
What is the single best option for management?

QUESTION ID: 1083

1. A. General anaesthesia with patient prone, followed by a posterior approach to the cervical spine to reduce and stabilise the spine. MRI scan of her cervical spine following reduction.
2. B. General anaesthesia with patient supine, followed by an anterior approach to the C spine for removal of the herniated disc and then reduction of the dislocation +/- fixation.
3. C. General anaesthesia with patient supine, followed by cervical in line traction with increasing weights and serial radiography until reduction is achieved. MRI scan of her cervical spine following reduction.
4. D. With patient supine perform awake in line traction with increasing weights and serial radiography in theatre and neurological examination to achieve reduction. CT scan of her cervical spine following reduction.
5. E. With patient supine perform awake in line traction with serial radiography in theatre. Once reduced place patient in a hard collar and follow up in 4 weeks with extension/flexion radiography of the cervical spine.