• Hakan Pilge, Peter M Prodinger, Dominik Bürklein, Boris M Holzapfel, and Jochen Lauen.
• Klinikum Schwabing, Department of Pediatric Orthopedics, Clinic for Orthopedic Surgery and Traumatology, Klinikum Rechtrs der Isar, Technical University Munich, Koelner Platz 1, Munich, Germany. hakanpilge@web.de
• Spine. 2011 May 15; 36 (11): E747-51.

Study DesignCase report and review of the literature.ObjectiveWe report a case of Grisel's syndrome with a delayed diagnosis. The patient's first presentation in our pediatric orthopedics department was 2 month after surgery (cochlea implantation) with a persistent torticollis. Radiographs revealed a subluxated atlantoaxial joint. We treated our patient with manual repositioning and calculated antibiotics, which lead to a restitutio ad integrum within a short time.Summary Of Background DataGrisel's syndrome is synonymous with rare nontraumatic, rotational subluxation of the atlantoaxial joint (C1-C2). All formerly reported cases showed a clear association to infection or were related to head and neck surgery. Still, there is a lack of understanding about pathogenetic features and causative agents. In 1977 Fielding proposed a classification of the atlantoaxial subluxation and stage-related therapy was recommended.MethodsOur patient was a 11-year-old girl with a torticollis after insertion of a cochlea implant. After surgery, physiotherapy was performed because of her wryneck. As the symptoms did not improve, she was presented in our clinic. Our radiographs revealed a subluxated atlantoaxial joint.ResultsIn general anesthesia we performed a manual repositioning and she was temporarily immobilized with a cervical collar for 2 weeks. In addition, we administered calculated antibiotics, although CRP and leukocytes were not elevated. The follow up showed a good repositioning within a short time.ConclusionAt least in this case, our treatment led to shorter recovery and avoidance of halo fixation. Our new therapeutic approach to patients with Grisel's syndrome might lead to a shorter recovery.

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