Treatment of Cervical Spine Dislocations

To the Editor.—In a letter in the March 27 issue of The Journal, Dr. Maurice W. Nicholson suggests that "dislocations and fractures of the cervical spine can be treated in a more efficacious manner than that outlined in the Fracture OF THE Month (218:1288, 1971)." Nicholson then states that "approximately 14 years ago, Cloward started fusing this type of fracture dislocation by the anterior route, and for the past six years I have done so in the same manner."The case in question was a dislocation with locked facets without relevant fracture. We would agree with Nicholson that the anterior approach is applicable to selected fracture dislocations, but not to anterior dislocation with locked facets, since in the latter case the block to reduction is posterior and cannot be visualized from the anterior approach.