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Torticollis in children: can dynamic computed tomography help determine severity and treatment
Kevin J McGuire1, Jeff Silber, John M Flynn
1Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA. kmcguire@alumni.princeton.edu
Insights
A new dynamic computed tomography scanning (DCTS) staging system for diagnosing atlantoaxial rotatory subluxation (AARS) in children with torticollis shows higher stages correlate with longer symptom duration and more intensive treatment.
Area of Science:
- Pediatric Orthopedics
- Radiology
- Medical Imaging
Background:
- Atlantoaxial rotatory subluxation (AARS) is a common cause of torticollis in children.
- Dynamic computed tomography scanning (DCTS) is the preferred imaging method for AARS diagnosis.
- Current DCTS protocols lack a standardized system for grading AARS severity.
Purpose of the Study:
- To develop and validate a DCTS-based staging system for AARS in pediatric torticollis patients.
- To correlate DCTS findings with symptom duration and treatment intensity.
Main Methods:
- Fifty children with torticollis underwent DCTS for AARS evaluation.
- DCTS images were analyzed to classify C1-C2 relative rotation into three stages (0, 1, 2) based on motion limitation and midline crossing.
- Symptom duration and treatment intensity were compared across stages.
Main Results:
- Out of 50 patients, 8 were stage 0, 30 were stage 1, and 12 were stage 2.
- Mean symptom onset to diagnosis was 6.7 days (stage 0), 8.6 days (stage 1), and 20 days (stage 2).
- A significant positive correlation was observed between higher AARS stages and increased symptom duration and treatment intensity.
Conclusions:
- The proposed DCTS staging system effectively categorizes AARS severity in pediatric torticollis.
- This classification aids in predicting symptom duration and guiding treatment intensity.
- DCTS staging provides a valuable tool for managing pediatric AARS.
Abstract:
For children with torticollis, dynamic computed tomography scanning (DCTS) is the imaging modality of choice in diagnosing atlantoaxial rotatory subluxation (AARS). At present, there is no grouping system based on DCTS to determine severity and direct treatment. Fifty children with torticollis underwent DCTS in the workup for AARS. The relative rotation of C1 versus C2 was compared for left and right rotation views. Each DCTS was classified: stage 0, torticollis but normal DCTS; stage 1, limitation of motion (<15 degrees difference between C1 and C2, but C1 crosses midline of C2); and stage 2, fixed (C1 does not cross midline of C2). Duration of symptoms and treatment were compared. There were 27 girls and 23 boys with a mean age of 8.2 years. There were 8 stage 0, 30 stage 1, and 12 stage 2 DCTS. Average onset of symptoms to diagnosis was 6.7 days for stage 0, 8.6 days for stage 1, and 20 days for stage 2. A significant trend was found between increasing intensity of treatment and stage. Using this grouping system, the authors found that patients with a higher stage had an increase in the mean duration of symptoms and intensity of treatment.