Atlantoaxial rotatory displacement in children

Area of Science:

• Pediatric Radiology
• Orthopedic Surgery
• Neurosurgery

Background:

• Torticollis is a common condition in children, often presenting with neck pain.
• Accurate classification is crucial for guiding treatment and predicting outcomes.

Purpose of the Study:

• To correlate the Pang and Lee classification system with the clinical course of patients experiencing painful torticollis.
• To evaluate the utility of dynamic rotational computed tomography (CT) in diagnosing and classifying torticollis.

Main Methods:

• Classified 47 dynamic rotational CT scans from 35 patients into five Pang and Lee types.
• Compared CT classifications with radiologist reports and clinical follow-up data.
• Analyzed clinical courses across the five defined subtypes.

Main Results:

• 26% of cases showed pathologic rotation (fixation or subluxation), 45% were muscular torticollis, and 28% were in a diagnostic grey zone.
• Radiologist interpretation showed discordance in 45% of cases.
• Clinical resolution was observed in 27 of 29 patients with follow-up; one patient with fixed rotatory subluxation required surgery.

Conclusions:

• The Pang and Li classification effectively characterizes rotational abnormalities in torticollis, improving communication among clinicians.
• Further research is needed to refine the indications for dynamic CT scans in evaluating torticollis.