Pasquale Anania1, Piero Pavone2, Mattia Pacetti3, Monica Truffelli4, Marco Pavanello3, Marcello Ravegnani3, Alessandro Consales3, Armando Cama3, Gianluca Piatelli3. 1. Neurosurgery, Pediatric Hospital Giannina Gaslini, University of Genoa, Genoa, Italy; Neurosurgery, Department of Neurosciences (DINOGMI), Policlinico San Martino, University of Genoa, Genoa, Italy. Electronic address: pas.anania@gmail.com. 2. Department of Pediatrics, University Hospital B Policlinico-Vittorio Emanuele, Catania, Italy; Department of Pediatrics, AOU Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy. 3. Neurosurgery, Pediatric Hospital Giannina Gaslini, University of Genoa, Genoa, Italy. 4. Neurosurgery, Pediatric Hospital Giannina Gaslini, University of Genoa, Genoa, Italy; Neurosurgery, Department of Neurosciences (DINOGMI), Policlinico San Martino, University of Genoa, Genoa, Italy.
Abstract
BACKGROUND: Nontraumatic atlantoaxial subluxation, also known as Grisel syndrome, is a rare disease that usually affects children. The typical presentation is torticollis in patients with a history of surgical operations or airway infections. METHODS: We describe 5 patients with Grisel syndrome, referring to medical care for a torticollis, a few weeks after an airway infection, with no trauma associated. Radiologic confirmation of the diagnosis, with computed tomography and magnetic resonance imaging studies, was carried out. RESULTS: The patients were treated with external immobilization for 3 months, followed by surgical fixation in the case of recurrence after collar removal or inveterate subluxation. We performed a review of the literature to define the best management of this disease. CONCLUSIONS: Management of Grisel syndrome depends on the degree of subluxation basing on the Fielding and Hawkins classification. The initial nonsurgical management consists of close reduction and immobilization. Surgical fixation is indicated in cases of conservative treatment failure.
BACKGROUND:Nontraumatic atlantoaxial subluxation, also known as Grisel syndrome, is a rare disease that usually affects children. The typical presentation is torticollis in patients with a history of surgical operations or airway infections. METHODS: We describe 5 patients with Grisel syndrome, referring to medical care for a torticollis, a few weeks after an airway infection, with no trauma associated. Radiologic confirmation of the diagnosis, with computed tomography and magnetic resonance imaging studies, was carried out. RESULTS: The patients were treated with external immobilization for 3 months, followed by surgical fixation in the case of recurrence after collar removal or inveterate subluxation. We performed a review of the literature to define the best management of this disease. CONCLUSIONS: Management of Grisel syndrome depends on the degree of subluxation basing on the Fielding and Hawkins classification. The initial nonsurgical management consists of close reduction and immobilization. Surgical fixation is indicated in cases of conservative treatment failure.