Torticollis with Atlantoaxial Rotatory Subluxation in Children: A Clinical Review

Abstract

A small proportion of children with a sudden onset torticollis (“wry neck”) presents with an atlantoaxial rotatory subluxation, usually after mild trauma or recent head or neck infection. Torticollis is a clinical diagnosis and imaging is usually not indicated, though often performed in clinical practice. Atlantoaxial rotatory subluxation on imaging is often a physiological phenomenon in torticollis, and concomitant neurological symptoms are therefore rare. Treatment is primarily conservative, with analgesics, a rigid neck collar, and if needed benzodiazepines to counteract muscle spasms and anxiety. In case of treatment failure or chronic subluxation, cervical repositioning and fixation under general anesthesia may be considered. Surgical treatment is only indicated in a small percentage of patients with chronic refractory subluxation, concomitant cervical fractures, or congenital anomalies. Early diagnosis and treatment are important, since this is associated with a more successful conservative outcome than a prolonged approach.

Keywords

atlantoaxial rotatory subluxation - torticollis - pediatrics

Disclosures

This article is largely based on a previous published Dutch article in the Dutch magazine “Tijdschrift voor Neurologie en Neurochirurgie.”[19]

Publication History

Received: 02 December 2023

Accepted: 21 April 2024

Accepted Manuscript online:
24 April 2024

Article published online:
15 May 2024

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