• Pasquale Anania, Piero Pavone, Mattia Pacetti, Monica Truffelli, Marco Pavanello, Marcello Ravegnani, Alessandro Consales, Armando Cama, and Gianluca Piatelli.
• 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.
• World Neurosurg. 2019 May 1; 125: 374-382.

BackgroundNontraumatic 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.MethodsWe 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.ResultsThe 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.ConclusionsManagement 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.Copyright © 2019 Elsevier Inc. All rights reserved.

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