Bilateral joint dislocation of cervical spine is an extremely difficult problem in the clinical work of crestal trauma, and such trauma patients are often combined with crestal marrow injury. From October 1996 to June 2000, we adopted cranial ring traction under manipulative repositioning to treat 30 cases of this kind of injury and achieved satisfactory results. Now we summarize the advantages of cranial ring traction under manipulative repositioning in treating bilateral joint dislocation of cervical spine and share them with you. I. Selection of patients with bilateral synovial joint dislocation of cervical spine A total of 30 patients with bilateral synovial joint dislocation of cervical spine were selected, including 23 male patients and 7 female patients. The minimum age was 14 years old, the maximum age was 63 years old, and the average age was 40 years old. The causes of injury included: fall from height, fall, traffic accident, and sports injury. The minimum time from injury to hospital admission was 3 hours and the minimum time was 8 days. The injury sites included C3~4, C4~5, C5~6 and C6~7 segments. All 30 patients had neck pain, limitation of movement and different degrees of crestal medullary injury. Second, imaging examination 30 patients underwent frontal and lateral cervical spine X-rays, some of which were supplemented by double oblique cervical spine films, which showed a common result of forward slippage of the upper cervical spine, with the bilateral inferior articular processes located in front of the inferior cervical superior articular processes or in a “perched” state on one side, and a significant widening of the spinal space, in addition, the X-rays also showed: fracture of the spinous process, fracture of the vertebral plate. MRI was performed in 28 patients, which showed cervical spondylolisthesis with synovial locking and abnormal crestal medullary morphology, and in 23 patients, the findings were combined with disc herniation. This technique is based on the Eight Methods of Pinle Orthopedic Bone and is summarized in clinical practice, and is divided into three steps. Step 1: The patient is placed on his back, and cranial traction is performed under local anesthesia. The head of the bed is elevated, and an ankle sleeve or pelvic traction belt is worn. At the beginning of traction, the cervical spine is placed in a neutral or mildly flexed position (about 20#), not overflexed, and overextension is strictly prevented. The starting weight is calculated as 2.5kg for each vertebra, generally 10~15kg, not less than 7kg. closely observe the vital signs and limb activities during traction, and gradually increase the weight without aggravating the neurological symptoms, adding 2~4kg each time. take a lateral cervical spine film every 20~30 minutes to understand the joint synapse lock retraction. Step 2: If the articular process is detached or in the opposite top state and the vertebral body is not reset, perform the following maneuvers to try to reset. The operator stands on the right side of the patient, pushes the trachea to the left side, and presses the thumbs of both hands against the lower edge of the dislocated vertebral body in a posterior and inferior direction to produce a sagittal rotational force, while the remaining four fingers of both hands placed at the inferior cervical spinous process of the dislocated vertebral body on the posterior side of the neck are lifted to the anterior end. Hearing the popping sound or the patient’s own sense of bouncing reset, touching the neck step-like changes disappear, suggesting successful reset. Step 3 rotational reset: If the radiograph confirms that the spine is not reset or only one side is reset, then rotational manipulation is performed. The operator holds both sides of the head ring, and under continuous traction, the head is laterally flexed to one side and slowly rotated 30~45#, and a loud sound is often heard during the reset. In the same way, reset the other side. When resistance is encountered, the rotation is stopped immediately, otherwise it may lead to articular eminence fracture and nerve injury. After the successful repositioning was confirmed by radiographs, traction was adjusted to a mild posterior extension position and weight reduction was maintained to 3~5 kg. IV. Treatment results There were 29 cases of successful repositioning under transcranial ring traction and 1 case of failure in this group, with a success rate of 96.67%. The minimum time from the start of traction to the reset of the vertebral body was 30 minutes, and the maximum time was about 4 hours. V. Discussion The current status of treatment of bilateral cervical joint dislocation and the superiority of manual resetting under cranial ring traction. The treatment requires early repositioning to minimize the time of crestal medullary compression, reduce secondary damage, and create conditions for the recovery of neurological function. Previous repositioning methods can be broadly divided into two categories, namely, incisional repositioning and closed repositioning. The latter includes freehand resetting and cranial traction resetting. Due to the limitations of objective conditions, incisional repositioning often cannot be implemented immediately and there are complications such as surgical infection. The traction force of freehand reset is small, the direction and rotation force are difficult to master, and it is easy to aggravate the crestal marrow injury, so most scholars believe that cranial traction should be the preferred method. However, simple cranial traction restoration often takes a long time and has a low success rate because it only has the longitudinal retraction force, which can retract the strangulated articular processes but lacks the rotational restoration force. In contrast, although the manual repositioning has rotational repositioning force, the longitudinal traction force is insufficient. Therefore, we envisioned that the organic combination of cranial ring traction and manipulation could complement each other’s strengths and greatly improve the success rate of repositioning. Clinical practice proves that our idea is feasible and effective. Complications and related problems There is no definite conclusion on the safety upper limit of cranial traction weight. The domestic general opinion is that it should not exceed 10~15kg, otherwise there is a risk of excessive traction. Foreign scholars recognize that less than 40~50 pounds (18~22.5kg) is a safer traction weight. We appreciate that the traction weight should be determined by the individual’s physical condition and dislocation segment. On the one hand, in the process of traction, the traction weight often cannot be fully applied to the cervical spine because of the resistance of the rope and pulley, the head ring and the bed surface, etc. The final traction force on the cervical spine is lower than the traction weight, and the actual traction force will not exceed the violence suffered at the time of injury before the strangulated synapses have been drawn open, so the crestal medullary injury will not be caused by excessive traction in general. In addition, because the sagittal diameter of the spinal canal is slightly increased in the cervical flexion position, the sagittal diameter of the dural crest is also 2~3 mm larger than that in cervical hyperextension, and the crestal medulla itself is thinner than that in cervical hyperextension, so the damage to the crestal medulla will not be aggravated. The incidence of neurological complications has not been clearly reported in the literature. In our group of cases, only one case showed aggravation of neurological symptoms during unilateral repositioning while hyperextension and recovered satisfactorily after surgical repositioning. Therefore, we believe that the problem of complications is inevitable with any treatment method, and the present method is no exception. Paraplegia secondary to cervical subluxation after reset is caused by improper resetting of the cervical spine, overweight cranial traction, incorrect direction and protrusion of the intervertebral disc or compression of the anterior dural hematoma after reset. Complications can be avoided if cranial traction is performed correctly, proper techniques are adopted, and experienced physicians operate.