Rotary atlanto-axial subluxation with torticollis following central-venous catheter insertion

Area of Science:

• Pediatric Orthopedics
• Anesthesiology
• Neurosurgery

Background:

• Atlanto-axial subluxation with torticollis is an uncommon pediatric condition.
• Etiologies include pharyngeal infection, minor trauma, neck surgery, and passive neck motion during general anesthesia.
• Torticollis is the most frequent clinical presentation, with pain often associated with passive neck movement.

Observation:

• This case report details atlanto-axial subluxation with torticollis as a complication following central venous catheter insertion in a pediatric patient under general anesthesia.
• The clinical presentation of torticollis post-central venous catheter placement should raise suspicion for this pathology.

Findings:

• Aggressive neck rotation and extension during general anesthesia, regardless of cervical inflammation, may contribute to atlanto-axial subluxation.
• Children with Down's syndrome are at higher risk and require particular attention to head and neck positioning.

Implications:

• Early diagnosis of atlanto-axial subluxation with torticollis is crucial for optimal outcomes.
• Delayed diagnosis can necessitate surgical intervention, highlighting the importance of prompt recognition and management.