title: A novel technique to treat Grisel's syndrome: results of a simplified, therapeutical algorithm.
abstract: OBJECTIVE
  Grisel's syndrome is a rare entity and usually develops in paediatric patients after otolaryngologic surgery or infection. It is defined as a fixed torticollis combined with a rotatory atlanto-axial subluxation. The success rate of physiotherapy is low. Conventional therapy concepts imply stage-related recommendations based on the Fielding classification (type I-IV). This classification was introduced in 1977 to assess the degree of subluxation between atlas (C1) and axis (C2). Thus, instability increases from type I to IV. Higher stages may require surgical intervention. The purpose of this study was to evaluate the value of an alternative, less invasive treatment protocol in Grisel's syndrome.
  
  
  METHODS
  Irrespective of the underlying Fielding type we treated five children (Fielding type I-III) by manual repositioning under general anaesthesia. Consecutively, the cervical spine was immobilized with a Minerva cast for four to eight weeks. Additional surgical treatment or immobilization in a Halo-Fixateur was not necessary.
  
  
  RESULTS
  Overall period of treatment was reduced, even in patients with delayed diagnosis. No case of recurrence was observed within a follow-up of six months.
  
  
  CONCLUSIONS
  Current conventional recommendations suggest invasive treatment with Halo-Fixateur in patients with higher degrees of subluxation (e.g., Fielding type III) or after delayed diagnosis. Even in those patients, this novel therapy concept enables us to achieve excellent clinical results without surgical intervention.
authors: Department of Orthopedics and Sports Medicine, Technische Universität München, Munich, Germany. Hakan.Pilge@med.uni-duesseldorf.de
authors: Hakan
authors: H
authors: Pilge
authors: Boris Michael
authors: BM
authors: Holzapfel
authors: Renee
authors: R
authors: Lampe
authors: Stefanie
authors: S
authors: Pilge
authors: Peter Michael
authors: PM
authors: Prodinger
mesh_terms: D000293:Adolescent; D000465:Algorithms; D001268:Atlanto-Axial Joint; D002648:Child; D015897:Comorbidity; D005260:Female; D006801:Humans; D004204:Joint Dislocations / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D008349:Manipulation, Orthopedic / Q000379:methods; D019637:Orthopedic Procedures / Q000379:methods; D012149:Restraint, Physical / Q000379:methods; D012189:Retrospective Studies; D014103:Torticollis / Q000453:epidemiology / Q000628:therapy*; D016896:Treatment Outcome
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