| 제목 |
Management of Non-traumatic Atalanto-axial Subluxation; Grisel's Syndrome in Children |
| 소속 |
Asan Medical Center, University of Ulsan College of Medicine, Department of Rehabilitation Medicine 1 |
| 저자 |
Minji Jung, MD1*, In Young Sung, MD1†, Eun Jae Ko, MD1 |
PURPOSE
Grisel syndrome is a non-traumatic atlantoaxial subluxation and a rare complication of any inflammatory condition defined as an atlanto-axial instability from inflammatory ligamentous laxity in the head. Delayed diagnosis causes neurological impairment, ranging from radiculopathy to paralysis and death.
METHODS
Records of pediatric patients diagnosed radiologically and clinically with AARS between January 1998 and January 2018 were retrospectively reviewed. Of 173 patients identified, 159 were traumatic AARS and 14 were non-traumatic AARS. Only 5 out of 14 patients were classified as Grisel syndrome. 1 were male and 4 were female on average 7.2 years of age (range 4–11 years).
RESULTS
Causes of Grisel’s syndrome included retropharyngeal infection (N=3), mucocutaneous lymph node syndrome (N=1), upper repiratory infection (N=1). Symptom duration varied: 3 patients who diagnosed AARS in early stage and recovered only with antibiotic therapy had symptoms for 11 days (range 8-12 days), 2 patients who began halter traction treatment 25 days and 30 days after AARS diagnosis respectively had symptoms for 117.5 days. In 1 patient halter traction management failed and required halo vest to reduce the subluxation for 3 months. In 1 patient underwent initial halter traction, but after 25 days of symptom resolved, subluxation progressed again. 13 days of halter traction was placed additionally, and Minerva orthosis was applied for 1 month to make sure resolution of AARS.
CONCLUSION
Grisel’s syndrome remains a rare, but potentially lethal children condition. Patients presenting acutely without neurological deficits can likely undergo antibiotics and collar therapy; those in whom the subluxation cannot be reduced may require traction and/or halo vest or Minerva orthosis. Early diagnosis with appropriate treatment is crucial to its management and prognosis.
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