title: Nontraumatic subluxation of the atlanto-axial joint as rare form of acquired torticollis: diagnosis and clinical features of the Grisel's syndrome.
abstract: METHODS
  Case report and review of the literature.
  
  
  OBJECTIVE
  We 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.
  
  
  BACKGROUND
  Grisel'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.
  
  
  METHODS
  Our 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.
  
  
  RESULTS
  In 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.
  
  
  CONCLUSIONS
  At 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.
authors.affiliation: 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
authors.forename: Hakan
authors.initials: H
authors.lastname: Pilge
authors.forename: Peter M
authors.initials: PM
authors.lastname: Prodinger
authors.forename: Dominik
authors.initials: D
authors.lastname: Bürklein
authors.forename: Boris M
authors.initials: BM
authors.lastname: Holzapfel
authors.forename: Jochen
authors.initials: J
authors.lastname: Lauen
mesh_terms: D001170:Arthritis, Infectious / Q000175:diagnosis* / Q000382:microbiology; D001268:Atlanto-Axial Joint / Q000382:microbiology* / Q000503:physiopathology; D002648:Child; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000175:diagnosis* / Q000382:microbiology*; D013530:Surgical Wound Infection / Q000175:diagnosis* / Q000382:microbiology; D013577:Syndrome; D014103:Torticollis / Q000175:diagnosis* / Q000382:microbiology*