Grisel's syndrome

Mini-lecture for Grisel's syndrome.
for the residents of PMR in Korea

1. A pain in the neck: Grisel’s syndrome
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2. A pain in the neck: Grisel’s syndrome
2022. 3. 7.Stilwell, P. A., Fine, D., Roberts, J. & Goh, L. A pain in the neck: Grisel’s syndrome. Arch Dis Child 104, 610 (2019)
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3. •7-year-old girl with severe neck stiff
nessand trismus on treatment for a
presumed throat infection
•Fixed torticollis with restricted neck
movements in all directions
•Erythematous tonsils and cervical ly
mphadenopathy
•Group A strep was cultured
•Diabetes mellitus, coincidentally
•CT neck with contrast
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2022. 3. 7.

4. 4
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5. •Initial management
•Soft neck collar
•Analgesia
•Diazepam
àUnsuccessful
•Manipulation under anesthesia
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2022. 3. 7.

6. Grisel’s syndrome
•Non-traumatic subluxation of atlant
o-axial joint (C1/C2)
•Caused by inflammation of adjacent
tissue
•Relaxed transverse ligament of A-A
joint
•Progressive throat and neck pain
•And/or neck stiffness
•Neck rotation LOM
•Unusual cause of acute torticollis
•Rare complication of adenoidectom
y and/or tonsillectomy
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2022. 3. 7.

7. Grisel’s syndrome -Diagnosis
•Imaging
•X-ray / CT / MRI
•Fielding & Hawkins classification of
C1-C2 rotatory subluxation
•Type I: rotatory fixation without anterior
displacement of atlas (≤ 3 mm)
•Type II: rotatory fixation with anterior di
splacement of atlas of 3-5 mm.
•Type III: rotatory fixation with anterior di
splacement of atlas of > 5 mm.
•Type IV: rotatory fixation with posterior
displacement of atlas.
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2022. 3. 7.BoccioliniC, Dall'OlioD, CunsoloE, CavazzutiPP, LaudadioP. Grisel's syndrome: a rare complication following adenoidectomy.Acta OtorhinolaryngolItal. 2005;25(4):245-249.

8. Plane X-ray
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2022. 3. 7.

9. 9
2022. 3. 7. https://radiopaedia.org/cases/atlantoaxial-subluxation-1?lang=us

10. CT
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11. 11
2022. 3. 7. https://radiopaedia.org/cases/atlanto-axial-subluxationdislocation?lang=us

12. Dynamic CT
2022. 3. 7.Park, S.-H., Park, S.-H. & Lee, S.-H. Grisel Syndrome: Pathophysiological Evidence from Magnetic Resonance Imaging Findings. AnnRehabilitation Medicine 37, 713–716 (2013)
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13. The initial T2-weighted magnetic
resonance imaging (MRI) study s
hows enhancement of atlantoden
talinterval (A) and superior articu
lar facet of axis (B). Repeated M
RI, 16 days later, shows disappe
arance of signal change in atlant
o-dental joint (C) and superior fa
cet articulation of axis (D).
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2022. 3. 7.Park, S.-H., Park, S.-H. & Lee, S.-H. Grisel Syndrome: Pathophysiological Evidence from Magnetic Resonance Imaging Findings. AnnRehabilitation Medicine 37, 713–716 (2013)

14. 2022. 3. 7.Park, S.-H., Park, S.-H. & Lee, S.-H. Grisel Syndrome: Pathophysiological Evidence from Magnetic Resonance Imaging Findings. AnnRehabilitation Medicine 37, 713–716 (2013)
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15. Treatment
•Protection
•Neck collar
•No excessive manipulation
•Early detection
•Adequate antibiotics
•Anti-inflammationtreatment
•Halter traction(Cervical traction)
•Delayed treatment may lead
•Persistent torticollis
•Delayed external fixation
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2022. 3. 7.

16. 2022. 3. 7.Park, H.-J., Kwon, K., Kim, W.-K., Shim, Y.-J. & Kwon, S. Non-traumatic Atlanto-axial Rotatory Subluxation -A Case Report -. J Korean Soc Spine Surg 19, 59–63 (2011)
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17. 2022. 3. 7.Park, H.-J., Kwon, K., Kim, W.-K., Shim, Y.-J. & Kwon, S. Non-traumatic Atlanto-axial Rotatory Subluxation -A Case Report -. J Korean Soc Spine Surg 19, 59–63 (2011)
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18. Manipulation?
2022. 3. 7.Hill, C. S., Borg, A., Tahir, M. Z. & Thompson, D. N. P. Atlantoaxial rotatory fixation in childhood: a staged management strategy incorporating manipulation under anaesthesia.
Child’s NervSyst 37, 167–175 (2021).
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19. •General anesthesia
•Fluoroscopic guidance
•IOP monitoring
•Gentle traction
•Followed by rotation, counterwise
•Orthosis
•Miami J
•HBO body orthosis
•Surgical fixation for failed patients
•C1-2 lateral mass screw fixation
•Modified Gallieprocedures with sublam
inar cables
•C-C2 fixation with C1 decompression
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2022. 3. 7.Hill, C. S., Borg, A., Tahir, M. Z. & Thompson, D. N. P. Atlantoaxial rotatory fixation in childhood: a staged management strategy incorporating manipulation under
anaesthesia. Child’s NervSyst 37, 167–175 (2021).

20. Prognosis
2022. 3. 7.Spinnato, P. et al. Atlantoaxial rotatory subluxation/fixation and Grisel’s syndrome in children: clinical and radiological prognostic factors. Eur J Pediatr180, 441–447 (2021)
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21. Traumatic AARF
•AARF: atlanto-axial rotatory fixation
2022. 3. 7.
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22. EŽääî.