Recurrent Torticollis and Cervical Subluxation in a Pediatric Patient

Background: Atlantoaxial subluxation (AAS), also referred to as C1-C2 subluxation, is a misalignment of the first two vertebrae of the cervical spine. AAS typically presents with a head tilt (torticollis) with limited range of motion (ROM). Torticollis is quite common in infants, but in older children, torticollis may be an indication of AAS. Method: In this retrospective case study, the clinical history of a female pediatric patient diagnosed with atlantoaxial subluxation presenting with recurrent torticollis is reviewed. Result: The patient was initially diagnosed with torticollis during infancy; torticollis partially resolved. However, after an ear infection, the child again developed torticollis secondary to Grisel’s Syndrome. Despite undergoing physical therapy treatments, torticollis persisted. The patient was referred to neurosurgery at age nine. AAS was diagnosed after a three-dimensional (3D) computed tomography (CT) scan. The child was subsequently placed in halo-traction to reduce the C1-C2 subluxation. Once the alignment was acceptable, the child was placed in a halo vest. However, even after several months of noninvasive cervical spine immobilization with a halo vest and hard cervical collar, the head tilt and cervical subluxation recurred due to bone remodeling. Conclusion: The diagnosis of AAS requires both a comprehensive physical examination and imaging following presentation of torticollis. Understanding the etiology of the torticollis early on is critical in preventing the occurrence of AAS after treatment.

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Atlantoaxial subluxation in the pediatric patient: Case series and literature review

Journal of Neuroscience and Neurological Disorders ◽

10.29328/journal.jnnd.1001037 ◽

2020 ◽

Vol 4 (2) ◽

pp. 069-074

Author(s):

Mazzola Catherine A ◽

Christie Catherine ◽

Snee Isabel A ◽

Iqbal Hamail

Keyword(s):

Cervical Spine ◽

Imaging Techniques ◽

Case Series ◽

Atlantoaxial Subluxation ◽

Upper Cervical Spine ◽

Atlantoaxial Joint ◽

Retrospective Case ◽

Ligamentous Laxity ◽

Halo Traction ◽

Increased Risk

Objective: Atlantoaxial subluxation (AAS) occurs when there is misalignment of the atlantoaxial joint. Several etiologies confer increased risk of AAS in children, including neck trauma, inflammation, infection, or inherent ligamentous laxity of the cervical spine. Methods: A single-center, retrospective case review was performed. Thirty-four patients with an ICD-10 diagnosis of S13.1 were identified. Demographics and clinical data were reviewed for etiology, imaging techniques, treatment, and clinical outcome. Results: Out of thirty-four patients, twenty-two suffered cervical spine trauma, seven presented with Grisel’s Syndrome, four presented with ligamentous laxity, and one had an unrecognizable etiology. Most diagnoses of cervical spine subluxation and/or instability were detected on computerized tomography (CT), while radiography and magnetic resonance imaging (MRI) were largely performed for follow-up monitoring. Six patients underwent cervical spine fusion, five had halo traction, twelve wore a hard and/or soft collar without having surgery or halo traction, and eight were referred to physical therapy without other interventions. Conclusion: Pediatric patients with atlantoaxial subluxation may benefit from limited 3D CT scans of the upper cervical spine for accurate diagnosis. Conservative treatment with hard cervical collar and immobilization after reduction may be attempted, but halo traction and halo vest immobilization may be necessary. If non-operative treatment fails, cervical spine internal reduction and fixation may be necessary to maintain normal C1-C2 alignment.

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C1-C2 Subluxation after Mild Cervical Spine Trauma in a Child

Surgical Case Reports ◽

10.31487/j.scr.2020.07.17 ◽

2020 ◽

pp. 1-3

Author(s):

Isabel Snee ◽

Catherine A. Mazzola

Keyword(s):

Cervical Spine ◽

Head Tilt ◽

Spine Injury ◽

Halo Traction ◽

Cord Injury ◽

Magnetic Resonance Imaging Mri ◽

Cervical Spine Alignment ◽

Atlanto Axial Joint ◽

Spine Radiographs ◽

Halo Device

We report a case of a seven-year-old girl who presented with a “Cock-Robin” head tilt and cervical spine injury after falling from her bed. Initial cervical spine X-ray reported a fractured clavicle. However, almost four weeks later, the torticollis had not resolved. Computerized tomography (CT) of the cervical spine revealed subluxation of the atlanto-axial joint at C1-C2. Cervical spine magnetic resonance imaging (MRI) did not show any spinal cord injury. Manual reduction and hard collar placement were attempted, yet C1- C2 subluxation recurred. The child was placed into halo traction and then into a halo vest. CT scan showed near complete resolution of C1-C2 subluxation. Three months later the halo device was removed, and the patient was placed in a hard cervical collar then transitioned into a soft collar over a four month period. During this time, the patient received physical therapy. Final cervical spine radiographs revealed proper cervical spine alignment and resolution of C1-C2 subluxation.

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Cervical spine fracture-dislocation in patients with ankylosing spondylitis and severe thoracic kyphosis: application of halo vest before and during surgical management

Clinical Neurology and Neurosurgery ◽

10.1016/j.clineuro.2021.106744 ◽

2021 ◽

pp. 106744

Author(s):

Haisong Yang ◽

Haibin Wang ◽

Bangke Zhang ◽

Yuling Sun ◽

Liang Wang ◽

...

Keyword(s):

Cervical Spine ◽

Ankylosing Spondylitis ◽

Surgical Management ◽

Thoracic Kyphosis ◽

Spine Fracture ◽

Fracture Dislocation ◽

Cervical Spine Fracture ◽

Halo Vest

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What a Pain in the Neck!

Pediatric Traumatic Emergencies ◽

10.1093/med/9780190946623.003.0002 ◽

2020 ◽

pp. 13-22

Author(s):

Walter Wiswell ◽

Bryan McCarty

Keyword(s):

Decision Making ◽

Emergency Department ◽

Cervical Spine ◽

Neck Pain ◽

Pediatric Patient ◽

Ct Scans ◽

X Rays ◽

Pros And Cons ◽

Current Guidelines ◽

Patient Presentation

The chapter on cervical spine controversies in children describes what initial steps need to be taken in assessing a pediatric patient with neck pain after trauma, and discusses the decision-making process that goes into further evaluation and testing. Clinical actions and assessments of the patient on-scene, whether to pursue imaging once in the emergency department setting, and what imaging is most appropriate depending on the patient presentation are discussed. Indications and contraindications for cervical spine immobilization and spinal positioning, including proper techniques based on a patient’s age and whether or not such steps are necessary. It also discusses the pros and cons of x-rays, CT scans, and MRIs in the context of pediatric neck trauma, and current guidelines that should be followed when deciding to order such studies.

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Anterior cervical spine surgery-associated complications in a retrospective case-control study

Journal of Spine Surgery ◽

10.21037/jss.2017.08.03 ◽

2017 ◽

Vol 3 (3) ◽

pp. 444-459 ◽

Cited By ~ 26

Author(s):

Anastasia Tasiou ◽

Theofanis Giannis ◽

Alexandros G. Brotis ◽

Ioannis Siasios ◽

Iordanis Georgiadis ◽

...

Keyword(s):

Cervical Spine ◽

Spine Surgery ◽

Case Control Study ◽

Case Control ◽

Retrospective Case ◽

Cervical Spine Surgery ◽

Anterior Cervical Spine Surgery ◽

Control Study

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Airway Compromise from Prevertebral Soft Tissue Swelling during Placement of Halo-Traction for Cervical Spine Injury

Anesthesiology ◽

10.1097/00000542-199010000-00025 ◽

1990 ◽

Vol 73 (4) ◽

pp. 775-776 ◽

Cited By ~ 9

Author(s):

Timothy D. Meakem ◽

Thomas J. Meakem ◽

William Rappaport

Keyword(s):

Cervical Spine ◽

Soft Tissue ◽

Cervical Spine Injury ◽

Spine Injury ◽

Airway Compromise ◽

Halo Traction ◽

Soft Tissue Swelling ◽

Prevertebral Soft Tissue ◽

Prevertebral Soft Tissue Swelling

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The Treatment of Multiple Myeloma of the Cervical Spine with a Halo Vest

Journal of Spinal Disorders & Techniques ◽

10.1097/00024720-198912000-00009 ◽

1989 ◽

Vol 2 (4) ◽

pp. 263???267

Author(s):

Jean-Jacques Abitbol ◽

Michael J. Botte ◽

Steven R. Garfin ◽

Wayne H. Akeson

Keyword(s):

Multiple Myeloma ◽

Cervical Spine ◽

Halo Vest

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Halo Fixator and Halo Traction – Value for the Treatment of Spinal Disorders in Childhood

Zeitschrift für Orthopädie und Unfallchirurgie ◽

10.1055/a-1026-6698 ◽

2019 ◽

Cited By ~ 1

Author(s):

Christoph Eckhard Heyde ◽

Matthias Krause ◽

Jan-Sven Gilbert Jarvers ◽

Ulrich Josef Albert Spiegl ◽

Anna Völker ◽

...

Keyword(s):

Cervical Spine ◽

Early Age ◽

Spinal Disorders ◽

Extended Surgery ◽

Halo Traction ◽

Additional Stabilization ◽

Underlying Diseases

AbstractThe application of the Halo fixateur in case of spinal pathologies in childhood is a standardized technique. The halo fixateur may be used for treatment of injuries of the cervical spine, for additional stabilization following extended surgery at the cervical spine and their transitional regions as well as to achieve preoperative reduction in case of severe and rigid deformity. These indications are, referred to the early age, rare. However, the successful use of the Halo fixateur presumes a certain familiarity with the device and experiences regarding the underlying diseases to minimize related risks and to avoid possible complications. In this article the use and specific features regarding the application of the halo fixateur in childhood based on presented cases and the literature will be discussed.

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