Awake closed manual reduction of cervical spine dislocation as an emergency bridge to surgery: a case report

Background: Early closed reduction of cervical spine dislocation is essential for spinal cord decompression and neurological preservation. Standard techniques require either general anesthesia for manipulation or specialized traction devices such as Gardner-Wells tongs or halo systems. Awake manual reduction without such equipment or anesthesia has been rarely reported. Case presentation: A 74-year-old woman sustained a bilateral C5-C6 facet fracture-dislocation with incomplete spinal cord injury (ASIA grade C) following a traffic accident. Approximately 10 h after injury she arrived at our emergency department. Upon arrival, a prompt awake closed reduction was performed using freehand cervical manipulation without traction devices, guided by real-time patient feedback. No analgesia or sedation was administered before or during reduction. The patient remained fully conscious to allow continuous neurological monitoring. Successful reduction was achieved within 15 min with immediate improvement in pain and upper-extremity motor function. The patient subsequently underwent anterior cervical discectomy and fusion and demonstrated satisfactory neurological recovery at the 18-month follow-up. Conclusion: Awake closed manual reduction may serve as a feasible emergency bridge intervention for cervical fracture-dislocation in time-critical scenarios, such as during preoperative preparation or when the therapeutic window demands immediate decompression. This technique requires experienced practitioners and continuous neurological monitoring, and further studies are warranted to define its safety profile and optimal indications.