Non-traumatic Atlanto-axial Rotatory Subluxation- Grisels Syndrome Case Report and Literature ReviewAlqroom Y Rami1*, Jeszenszky DJ2, Michalitsis G Sotirios3 and Franke Jörg3
- Corresponding Author:
- Rami Alqroom Y, M.D
Spine surgeon, Department of Neurosurgery
Royal Medical Services
King Hussein Medical Center, Amman, Jordan
E-mail: [email protected]
Received date: May 23, 2016; Accepted date: June 13, 2016; Published date: June 15, 2016
Citation: Alqroom RY, Jeszenszky DJ, Michalitsis GS, Franke J (2016) Non-traumatic Atlanto-axial Rotatory Subluxation- Griselâs Syndrome Case Report and Literature Review. J Spine 5:312. doi:10.4172/2165-7939.1000312
Copyright: © 2016 Alqroom RY, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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).