- Usually the subluxation leading to torticollis is persistant
- Grisel’s syndrome
- rotatory subluxation linked to retropharangeal inflamation of an infectious etiology
- Usually after trivial trauma or after an URTI
- Rarely associated with neurologic complication
Classification of Atlantoaxial Rotary Displacement
- Feilding & Hawkins
| Type | Description |
|---|---|
| I | Simple rotary displacement without anterior shift of C1 |
| II | Rotary displacement with an anterior shift of 5 mm or lessAnterior displacement of greater than 3 mm in older children & adults & greater than 4 mm in younger children is considered pathologic |
| III | Rotary displacement with an anterior shift greater than 5 mm |
| IV | Rotary displacement with a posterior shift |
- Notes
- most common is type 1
- Type 3 & 4 are uncommon but can lead to neurologic compromise
Clinical
- Child usually has a crick in the neck & it lasts less than a week
- head is laterally tilted, rotated to the other side & flexed
- Spasm in the contralateral sternocleidomastoid
- Rarely this becomes chronic with persistant loss of ROM
- Neurologic compromise can occur
Differential Diagnosis
- Congenital torticolis
- Posterior fossa tumor
- Ocular problem
Imaging
- plain films may be difficult to interpret, however the mouth view may show assymetry of the lateral masses relative to the midline, the lateral may show assymetry
- CT scan is the gold standard
Treatment
- Mild symptoms < 1 week
- soft collar & analgesics
- Symptoms greater than a week & < 4 weeks
- bedrest, halter traction, muscle relaxants & analgesia
- If anterior displacement exists then consider careful reduction with traction followed by some form of immobilization for 6 months
- If > 1-3 months
- halo traction for reduction & reduction will often require later fusion
- > 3 months
- fixed deformity & C1 to C2 fusion is indicated
Surgical technique for Fusion
- wiring can be used if reduction is made – Brooks or Gallie
- in young children simply lying the bone on the decorticated C1 & C2 is adequate