Comprehensive treatment algorithm for atlanto-axial rotatory fixation (AARF) in children

Mahr, Daniel; Freigang, Viola; Bhayana, Himanshu; Kerschbaum, Maximilian; Frankewycz, Borys; Loibl, Markus; Nerlich, Michael; Baumann, Florian

doi:10.1007/s00068-019-01096-3

Cited by 11 publications

(9 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Early diagnosis based on clinical and radiological evaluation is crucial for prompt and appropriate management, which is particularly important in order to avoid neurologic sequelae. In our 2 cases, the early diagnosis and treatment allowed to avoid invasive treatment, thus supporting the algorithm proposed by Mahr et al [ 43 , 48 ]. Neurosurgical consultation should be obtained, and the choice of treatment should be based on the Fielding–Hawkins grading system.…”

Section: Discussionsupporting

confidence: 87%

“…Mahr and colleagues proposed a new treatment algorithm of GS, a “therapeutic crescendo,” which starts with a “wait and see” approach involving analgesic therapy and immobilization for the first 3 days and then manual closed reduction if the symptoms persists, followed by immobilization with the rigid collar. If the subluxation recurs, one attempt of manual closed reduction can be repeated, followed in this case by halo vest immobilization, but in case of further recurring subluxation, open reduction is then proposed [ 43 ]. Anania and colleagues have stressed the importance of choosing treatment according to whether the subluxation is recent (<1 month) or inveterate (>1 month) and proposed an algorithm which differs from those employed by PIlge and Mahr.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Grisel’s Syndrome in Children: Two Case Reports and Systematic Review of the Literature

Pini

Ceccoli

Bergonzini

2020

Case Reports in Pediatrics

View full text Add to dashboard Cite

Background and Objective. Grisel’s syndrome is a rare syndrome characterized by nontraumatic rotatory subluxation of the atlantoaxial joint. It usually affects children and typically presents with torticollis after ear, nose, and throat (ENT) surgery or head and neck infections. In the pediatric literature, there is only a small amount of available data; moreover, no systematic review has been previously done with focus on the pediatric population. We report our experience of two cases, and we provide a systematic review on Grisel’s syndrome in children in order to offer a deeper insight about its clinical presentation, its current diagnosis, and principles of treatment. Case Reports and Review. We describe two boys of 9 and 8 years old, who developed atlantoaxial subluxation after adenoidectomy. Considering the early diagnosis, a conservative treatment was chosen, with no recurrence and no sequelae at follow-up. We identified 114 case reports, of which 90 describe children, for a total of 171 pediatric patients. Of the 154 cases in which cause was reported, 59.7% presented a head and neck infection and 35.7% had previous head and neck surgery. There is no sex prevalence (49.7% males versus 50.2% females). Mean delay in diagnosis is 33 days. Eight % of the patients had neurological impairment of the 165 cases which mentioned treatment, 96% underwent a conservative treatment, of whom the 8.8% recurred with the need of surgery. As a whole, 12% underwent surgery as a first- or second-line treatment. 3 6% of the patients whose follow-up was reported developed a sequela, minor limitation of neck movement being the most frequent. Conclusion. Grisel’s syndrome should be suspected in children with painful unresponsive torticollis following ENT procedures or head and neck inflammation. CT scan with 3D reconstruction is the gold standard for diagnosis, allowing the identification of the subluxation and the classification according to the Fielding–Hawkins grading system. Surgical treatment is indicated in case of high-grade instability or failure of conservative treatment. Review of the literature shows how early diagnosis based on clinical and radiological evaluation is crucial in order to avoid surgical treatment and neurologic sequelae.

show abstract

Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Grisel’s Syndrome in Children: Two Case Reports and Systematic Review of the Literature

Pini

Ceccoli

Bergonzini

2020

Case Reports in Pediatrics

View full text Add to dashboard Cite

show abstract

“…Many studies classify patients as acute, chronic, and congenital based on the duration of symptom for treatment modality decision purpose, but the cut-off point for acute/chronic is variable. Acute AARS is generally considered benign, treated with less invasive closed reduction such as halter traction, followed by external immobilization or immobilization alone with good clinical outcome [ 66 , 69 ]. Persistent acute AARS cases together with chronic/congenital cases require either longer/repeated closed reduction, or more invasive traction devices such as Gardner-Wells-style tongs or halo vest but there is no consensus upon traction and stabilization period, the number of attempts before considered irreducible, and the type of traction device of choice [ 66 , 69 , 73 , 75 ].…”

Section: Pediatric Cervical Spine Traumamentioning

confidence: 99%

Pediatric Spine Trauma

Hyun

2022

J Korean Neurosurg Soc

View full text Add to dashboard Cite

Pediatric spine has growth potential with incomplete ossification, and also unique biomechanics which have important implications for trauma patients. This article intends to review various aspects of pediatric spine trauma including epidemiology, anatomy and biomechanics, and clinically relevant details of each type of injury based on the location and mechanism of injury. With the appropriate but not superfluous treatment, pediatric spine trauma patients can have better chance of recovery. Therefore, as a spine surgeon, understanding the general concept for each injury subtype together with the debate and progress in the field is inevitable.

show abstract

“…The SCM allows ipsilateral-lateral flexion and contralateral rotation; accordingly, tightness of the right SCM caused pain when the patient turned her head to the left [7]. The patient's asymmetrical head positioning likely caused fibrosis and hypertonia of the right SCM due to inactivity [3,7]. Missaghi describes the case of a 37-year-old female with gradually worsening unilateral neck pain after carrying her child for long periods of time with her left arm while performing tasks with her right arm; various physical examinations, including cervical flexion-extension and muscle strength and length tests, were performed leading to the determination of SCM tightness [7].…”

Section: Etiologymentioning

confidence: 99%

“…One of the most common findings of C1-C2 subluxation in physical examination is torticollis, an abnormal tilting of the head to one side. Although common in infants, in an older child, torticollis can indicate cervical spine instability or underlying muscle or bone (vertebral) deformities as well [3]. Due to the variability in torticollis etiologies, early diagnosis and treatment are essential in preventing progression of instability, subluxation, and optimizing the effectiveness of non-surgical and surgical treatment of C1-C2 subluxation.…”

Section: Introductionmentioning

confidence: 99%

Recurrent Torticollis and Cervical Subluxation in a Pediatric Patient

Iqbal¹,

Mazzola²

2020

SCR

View full text Add to dashboard Cite

Background: Atlantoaxial subluxation (AAS), also referred to as C1-C2 subluxation, is a misalignment of the first two vertebrae of the cervical spine. AAS typically presents with a head tilt (torticollis) with limited range of motion (ROM). Torticollis is quite common in infants, but in older children, torticollis may be an indication of AAS. Method: In this retrospective case study, the clinical history of a female pediatric patient diagnosed with atlantoaxial subluxation presenting with recurrent torticollis is reviewed. Result: The patient was initially diagnosed with torticollis during infancy; torticollis partially resolved. However, after an ear infection, the child again developed torticollis secondary to Grisel’s Syndrome. Despite undergoing physical therapy treatments, torticollis persisted. The patient was referred to neurosurgery at age nine. AAS was diagnosed after a three-dimensional (3D) computed tomography (CT) scan. The child was subsequently placed in halo-traction to reduce the C1-C2 subluxation. Once the alignment was acceptable, the child was placed in a halo vest. However, even after several months of noninvasive cervical spine immobilization with a halo vest and hard cervical collar, the head tilt and cervical subluxation recurred due to bone remodeling. Conclusion: The diagnosis of AAS requires both a comprehensive physical examination and imaging following presentation of torticollis. Understanding the etiology of the torticollis early on is critical in preventing the occurrence of AAS after treatment.

show abstract

Comprehensive treatment algorithm for atlanto-axial rotatory fixation (AARF) in children

Cited by 11 publications

References 18 publications

Grisel’s Syndrome in Children: Two Case Reports and Systematic Review of the Literature

Grisel’s Syndrome in Children: Two Case Reports and Systematic Review of the Literature

Pediatric Spine Trauma

Recurrent Torticollis and Cervical Subluxation in a Pediatric Patient

Contact Info

Product

Resources

About