The management of rotatory atlanto-axial subluxation in children.

Phillips, William A.; Hensinger, Robert N.

doi:10.2106/00004623-198971050-00004

Cited by 195 publications

(125 citation statements)

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“…A return to normal life activities and sports after 4 to 6weeks is suggested [8]. However, most cases usually resolve spontaneously up to 7 days after the beginning of treatment [20]. Once the luxation is reduced and the inflammatory process is completely solved, stability recovers.…”

Section: Discussionmentioning

confidence: 99%

Non-traumatic Atlanto-axial Rotatory Subluxation- Grisel’s Syndrome Case Report and Literature Review

Rami¹,

Dj²,

Sotirios³

et al. 2016

J Spine

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Study design: Case report of conservatively treated non-traumatic Atlanto-axial rotatory sublaxation.Objective: To report our case with this rare condition (non-traumatic Atlanto-axial rotatory subluxation-Grisel Syndrome) in a 9-year old girl presenting with torticollis and neck pain and literature review. Summary of background data:Atlanto-axial rotatory fixation or non-traumatic atlanto-axial subluxation which is usually secondary to an infection or an inflammation at the head and neck region is a rare subtype of subluxation in which a pathologic fixation of the atlas on the axis is present. It is most common in paediatric patients and it can be managed conservatively in the acute stage. In contrast, cases of chronic non-traumatic atlanto-axial rotatory subluxation are usually treated with operative reduction, according to literature data. Although high success rates have been achieved with operative reduction in chronic cases, a significant reduction in neck motion occurs due to the atlanto-axial fusion.Methods: A 9-year-old girl developed torticollis established longer than 10 weeks as a result of an upper respiratory tract infection. Computed tomography showed a type 1 rotatory subluxation of the Atlanto-axial joint according to the classification of Fielding and Hawkins. The patient was treated by manual reduction according to Jeszenszky (Jeszenszky transoral Citation Nr 22) under general anaesthesia and fluoroscopy control, and then a halo vest had been applied for 6 weeks. Results:We successfully treated this patient with chronic non-traumatic Atlanto-axial rotatory subluxation with manual reduction and immobilisation by applying a halo-body-jacket. She showed full recovery of neck motion and normal Atlanto-axial angle on clinical and radiological follow-up after 1 month and 3 months respectively. Conclusion:Chronic non-traumatic Atlanto-axial rotatory subluxation is a rare condition which can easily escape the attention of physicians especially in children. Conservative treatment with complete reduction under anaesthesia and subsequent immobilisation via halo-body-jacket for at least 6 weeks is a viable option as presented in this case report. Surgical treatment should be reserved only for cases of failure of conservative management (recurrence or irreducible subluxation).

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Section: Discussionmentioning

confidence: 99%

Non-traumatic Atlanto-axial Rotatory Subluxation- Grisel’s Syndrome Case Report and Literature Review

Rami¹,

Dj²,

Sotirios³

et al. 2016

J Spine

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“…Elimination of the muscle spasm leads to reduction of the rotatory subluxation. Phillips et al (8) treated 23 paediatric patients with AARS and reported that success of closed reduction is correlated with the duration of torticollis. Three of the 7 patients, who had torticollis for more than 1 month in the series, were treated with atlantoaxial arthrodesis.…”

Section: Discussionmentioning

confidence: 99%

Non-operative treatment in children and adolescents with atlantoaxial rotatory subluxation

Çiftdemir¹,

Çopuroğlu²,

Özcan³

et al. 2012

Balkan Med J

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“…Torticollis is the presenting syndrome, and the dislocation can be missed [2,15,25]. CT increases the likelihood of making the diagnosis [2,19,30] and, when images in rotation are obtained, is useful for evaluating reducibility of the lesion [2,14,26]. Fielding and Hawkins [12] distinguish four stages based on the extent of the shift of C1 on C2: type 1 is characterized by bilateral rotatory dislocation around the dens with a normal atlas-dens interval; type 2 by unilateral rotatory dislocation around one of the lateral masses with a 3-to 5-mm atlas-dens interval, indicating the presence of transverse ligament disruption; type 3 by a greater than 5-mm atlas-dens interval, indicating disruption of both the transverse ligament and the alar ligaments; and type 4 by posterior displacement of C1 due to failure of the dens.…”

Section: Discussionmentioning

confidence: 99%

“…If the trauma was minor, a collar, cervical traction [11,15], or manipulation [10] may allow reduction of the dislocation to be obtained. However, the success rate of conservative treatment drops if the diagnostic delay exceeds 1 month [26]. A severe trauma responsible for transverse ligament disruption can cause a combination of sagittal and rotatory dislocation.…”

Section: Discussionmentioning

confidence: 99%