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Midcervical postinfectious ligamentous instability: a variant of Grisel's syndrome
1Department of Neurosurgery, Children's Hospital of Buffalo, State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Buffalo, N.Y., 14222, USA.
Objective And Importance:
We report our recent experience with two cases of C3-C4 ligamentous instability that developed after the onset of an upper airway infection. To our knowledge, this is the first report in the literature of a variant of Grisel's syndrome occurring at the midcervical levels. The diagnosis and management of this entity are presented.
Clinical Presentation:
Two infants with respiratory distress were evaluated at the Children's Hospital of Buffalo. During evaluation, cervical spine x-rays showed midcervical translational instability. Neither patient had a neurological deficit nor a history of trauma or bone disease.
Intervention:
One of the patients was immmobilized with an external orthosis.
Conclusion:
Each patient remained neurologically intact, and the cervical spine returned to normal alignment after several months. We discuss a possible mechanism for this unusual association and recommend external immobilization.