Nontraumatic subluxation of the atlanto-axial joint: Case report and brief review

Abstract

Background: Grisel's Syndrome (GS) is a rare cause of non-traumatic torticollis in children. There is no deference between gender, occurring almost exclusively in children and young adults, with a higher prevalence at ages below 12 years. The GS diagnosis is challenging and requires a strong clinical suspicion and radiological investigation. Case report: Female, 7-years with a complaint of sudden-onset torticollis associated with the cephalic version for 9 months. The patient did not present a previous infection of the airways or prior otorhinolaryngological procedures. Neurological tests did not show abnormalities. A CT scan of the cervical spine showed a C1-2 rotatory subluxation with anterior displacement of the atlas greater than 5 mm in the dynamic test. The patient was treated with Halo Vest for 4 weeks, presenting a resolution of the pain and the anomalous head posture. Discussão: Conservative therapy with oral antibiotic and cervical immobilization can be effective in most of cases. Surgical treatment may be mainly necessary in type 3 and 4 Fielding and Hawkins' classification. In the present case, conservative treatment was instituted in type 3 patient́s and she had a complete recovery. Conclusion: GS should always be considered as a differential diagnosis in the presence of torticollis associated with an upper respiratory tract infection or a surgical procedure in the head or neck region, especially in children. The clinical suspicion together with a CT image determines the diagnosis. An early diagnosis of GS and immediate therapy is important due to avoid surgical intervention. This article aimed to report a successfully treated GS at our service and new insights into a poorly understood disease.

Keywords

• Grisel’s syndrome
• Torticollis in children
• Rotatory subluxation
• Nontraumatic subluxation