Mechanism of action and application goals
The primary goal of using Glisson's sling in conservative treatment is the complete unloading of the spinal column. The generated traction leads to a decrease in intradiscal pressure and relief of reflex muscle spasm. As a result of this process, reactive tissue edema naturally decreases and nerve root irritation subsides, leading to the alleviation of pain.
Traction for cervical and upper thoracic osteochondrosis
During an exacerbation of cervical and upper thoracic osteochondrosis, the device is used for vertical or horizontal traction.
To properly perform the procedure, the patient is placed in a strictly defined position:
- The patient lies on a rigid board.
- A small pillow is placed under the head.
- A roll with a groove or a pouch filled with warm sand is mandatory placed under the neck. This is necessary to maintain the physiological lordosis and achieve maximum relaxation of the neck muscles.
Use in traumatology (vertebral fractures)
In traumatological practice, Glisson's sling serves as the main tool for continuous non-skeletal traction in fractures of the cervical and upper thoracic vertebrae. Its operating principle is completely analogous to skeletal traction, but fixation is carried out externally using straps, loops, and cuffs.
This method belongs to gradual reposition techniques, where the elimination of bone fragment displacement occurs not instantaneously, but smoothly over a certain period of time.
Reposition technique:
- The device is securely fixed to the head end of the bed.
- For direct reduction of fragments, the head end of the bed is elevated to a height of 50–60 cm, creating powerful traction using the patient's body weight.
- After successful elimination of the displacement, the elevation height is necessarily reduced to 25–30 cm to maintain the achieved result long-term.
Comprehensive approach and pain management
Glisson's sling traction is often supplemented with other methods of conservative therapy. To quickly relieve severe pain in cervical osteochondrosis, a novocaine blockade of the anterior scalene muscle according to Popelyansky is used. The technique involves tilting the neck toward the painful side and turning the head to the healthy side; the injection is made along the lower edge of the muscle to a depth of 0.5–0.7 cm, injecting 2 ml of a 2% novocaine solution.
Drug support is also prescribed: analgesics and NSAIDs (ibuprofen, voltaren, movalis, rheopyrin), muscle relaxants (sirdalud) to enhance the muscle relaxation effect, decongestants (furosemide), and sedatives (nozepam). Additionally, physical therapy (novocaine electrophoresis, ultrasound, UV therapy) and manual therapy are used to work with vertebral-motor segments.
Anatomic features of the application area
The device affects the neck area, which has a complex innervation provided by the cervical plexus (plexus cervicalis). It is formed by the anterior rami of spinal nerves C1–C4 (while the posterior rami of C1 and C2 are thicker than the anterior ones).
The skin of the anterolateral region of the neck and the platysma are innervated by the superficial cervical loop (ansa cervicalis superficialis), in the formation of which the transverse cervical nerve (n. transversus colli) participates. The deep muscles lying below the hyoid bone receive motor signals from the deep cervical loop (ansa cervicalis profunda).
Important nuance: in medicine, one should not confuse the orthopedic sling with the Glisson's capsule of the liver. The latter is innervated by the right phrenic nerve (n. phrenicus), which also originates from the cervical plexus (branches C3, C4, sometimes C5). That is why in liver pathology, pain can radiate to the right half of the neck, mimicking radicular syndrome and requiring differential diagnosis with osteochondrosis.
To avoid confusing the terms on the exam: Glisson's sling pulls the neck from the outside (orthopedics), while Glisson's capsule hurts in the neck from the inside (liver anatomy and the right phrenic nerve).
Class and exam questions
What class of reposition methods does the use of Glisson's sling belong to?
This is a method of gradual reposition using continuous non-skeletal traction. Fragment displacement is eliminated not instantaneously, but smoothly over a certain period of time.
What is the bed elevation height during the reduction of cervical vertebral fractures?
At the active reposition stage, the head end of the bed is elevated by 50–60 cm. After successful fragment alignment, the height is reduced to 25–30 cm to maintain the effect.
How does Glisson's sling work during an exacerbation of osteochondrosis?
It provides spinal unloading, reduces intradiscal pressure, and relieves reflex muscle spasm. This leads to a decrease in reactive edema and nerve root compression.
What else to study on this topic
- Radiological and instrumental signs of osteochondrosis (CT, MRI, spondylography)
- Traction methods in mid-, lower thoracic, and lumbar osteochondrosis
- Technique of paravertebral and epidural novocaine blockades
- Anatomy and branches of the cervical plexus (plexus cervicalis)
- Formation of the deep and superficial cervical loops (ansa cervicalis profunda et superficialis)
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