Non-traumatic Atlanto-axial Rotatory Subluxation - A Case Report -

Park, Heui-Jeon; Kwon, Ki-youn; Kim, Wan-Ki; Shim, Young-Jun; Kwon, Sung-min

doi:10.4184/jkss.2012.19.2.59

J Korean Soc Spine Surg. 2012 Jun;19(2):59-63. Korean.
Published online Jun 30, 2012.
https://doi.org/10.4184/jkss.2012.19.2.59

Case Report

Non-traumatic Atlanto-axial Rotatory Subluxation - A Case Report -

Heui-Jeon Park, M.D., Ki-youn Kwon, M.D., Wan-Ki Kim, M.D., Young-Jun Shim, M.D. and Sung-min Kwon, M.D.

Author information

Author notes

Copyright and License

- Department of Orthopaedic Surgery, Wonju College of Medicine, Yonsei University, Korea.
Corresponding author: Ki-youn Kwon, M.D. Department of Orthopaedic Surgery, School of Medicine, Yonsei University, 162 Ilsan-dong, Wonju, Kangwon-do, Korea. TEL: 82-33-741-1352, FAX: 82-33-746-7326, Email: techkwon@nate.com

Received August 22, 2010; Revised October 17, 2011; Accepted November 07, 2011.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

A case report.

Objectives

To report a case of diagnostic, clinical and radiologic follow-up of a non-traumatic atlanto-axial rotatory subluxation.

Summary of Literature Review

Atlanto-axial rotatory subluxation, caused by a non-traumatic inflammation or infectious diseases, has been branded as "Grisel's syndrome". However, the pathophysiology of the syndrome has not been clearly understood, and its diagnostic criteria and appropriate treatment plans are not established.

Materials and Methods

The patient suffering from antlanto-axial subluxation without any neurological symptoms was treated with halter traction and Miami J brace.

Results

The patient maintained a normal reduction state, and a normal cervical movement was observed after undergoing 4 weeks of non-surgical treatment.

Conclusion

Early detection and treatment are essential and critical in avoiding catastrophic outcomes. It requires a combination of clinical assessment and appropriate radiographic imaging.

Keywords

Cervical spine; Atlanto-axial rotatory subluxation; Grisel's syndrome

Figures

Fig. 1
(A) Open mouth radiograph of the cervical spine showing asymmetry of the odontoid process in relation to the lateral masses of the atlas (arrowhead: center of odontoid, arrows: medial margin of lateral mass). (B) There is no definite deformity in lateral radiograph of the cervical spine. (C) Axial CT showing the face turned to the right as much as possible. (D) Coronal CT reconstruction showing asymmetry of the odontoid process in relation to lateral masses of the atlas (arrowhead: center of odontoid, arrows: medial margin of lateral mass). (E) 3D-CT reconstruction showing the fixation of the atlas lateral mass which has slipped forward and down in relation to axis(arrow).

Click for larger image

Fig. 2
(A) Open mouth radiograph of the cervical spine showing symmetry of the odontoid process in relation to the lateral masses of the atlas. (B) There is no definite deformity in lateral radiograph of the cervical spine. (C) Axial CT showing normal alignment. (D) Coronal CT reconstruction showing symmetry of the odontoid process in relation to lateral masses of the atlas. (E) 3D-CT reconstruction was confirmed the normal atlanto-axial alignment at last follow-up

Click for larger image

Fig. 3
The photographs show full range of cervical motion without pain at last follow up.

Click for larger image

References

1. El-Khoury GY, Clark CR, Gravett AW. Acute traumatic rotatory atlanto-axial dislocation in children. A report of three cases. J Bone Joint Surg Am 1984;66:774–777.
  PubMed
1. Fielding JW, Hawkins RJ. Atlanto-axial rotatory fixation. (Fixed rotatory subluxation of the atlanto-axial joint). J Bone Joint Surg Am 1977;59:37–44.
  PubMed
1. Guleryuz A, Bagdatoglu C, Duce MN, Talas DU, Celikbas H, Koksel T. Grisel's syndrome. J Clin Neurosci 2002;9:81–84.
  PubMed
  
  CrossRef
1. Meek MF, Hermens RA, Robinson PH. La maladie de Grisel: spontaneous atlantoaxial subluxation. Cleft Palate Craniofac J 2001;38:268–270.
  PubMed
  
  CrossRef
1. Bell C. In: The nervous system of the human body, embracing papers delivered to the royal society on the subject of nerves, 118. London: Longman, Rees and Orme; 1830. pp. 403.
1. Mezue WC, Taha ZM, Bashir EM. Fever and acquired torticollis in hospitalized children. J Laryngol Otol 2002;116:280–284.
  PubMed
  
  CrossRef
1. Wetzel FT, La Rocca H. Grisel's syndrome. Clin Orthop Relat Res 1989;240:141–152.
  PubMed
1. Yu KK, White DR, Weissler MC, Pillsbury HC. Nontraumatic atlantoaxial subluxation (Grisel syndrome): a rare complication of otolaryngological procedures. Laryngoscope 2003;113:1047–1049.
  PubMed
  
  CrossRef
1. Chang H, Park JB, Kim SK, Choi WS, Chun SK. Traumatic atlanto-occipital rotatory posterior dislocation combined with atlanto-axial rotatory subluxation. J Korean Soc Spine Surg 1998;5:326–332.
1. Hicazi A, Acaroglu E, Alanay A, Yazici M, Surat A. Atlantoaxial rotatory fixation-subluxation revisited: a computed tomographic analysis of acute torticollis in pediatric patients. Spine (Phaila Pa 1976) 2002;27:2771–2775.
  CrossRef
1. Phillips WA, Hensinger RN. The management of rotatory atlanto-axial subluxation in children. J Bone Joint Surg Am 1989;71:664–668.
  PubMed
1. Song KW. Posterior atlantoaxial fusion of the unstable cervical spine. J Korean Soc Spine Surg 2000;7:474–476.