Kerolus Mena, Jeans Elizabeth B, Fontes Ricardo B V, Deutsch Harel, Traynelis Vincent C
Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois.
Neurosurgery. 2015 Feb;76(2):E226-32; discussion E232. doi: 10.1227/NEU.0000000000000578.
Acquired atlantoaxial instability of inflammatory origin (Grisel syndrome) is a rare condition. It usually occurs in children with benign upper airway problems and responds well to immobilization, rarely requiring C1-2 arthrodesis. Our recent experience with 2 adult cases suggests this may not be true in an older subpopulation.
A 71-year-old man developed C1-2 instability in the setting of culture-negative endocarditis. Initial immobilization was attempted for 8 weeks but new imaging revealed progressive destruction of the odontoid and worsening instability. Symptoms resolved after C1-4 arthrodesis. A 35-year-old woman developed C1-2 instability after a molar extraction and otitis media. Despite 12 weeks of immobilization and antibiotics, symptoms persisted and the atlantodental interval increased. She was successfully treated with a C1-2 arthrodesis.
A literature review revealed 13 reports (14 cases) of inflammatory atlantoaxial instability in patients aged 18 and older since 1830. Including the 2 cases reported here, 11 cases underwent initial nonoperative treatment with durable satisfactory results in only 2 of them (18.2%). Aspiration of the C1-2 phlegmon was diagnostic in only 4 of these 16 cases. Destruction of the odontoid was seen in a minority of cases (5/16, 31.3%). In this first review of the topic since the introduction of screw-based C1-2 fixation, it is suggested that nonoperative treatment is futile for inflammatory atlantoaxial instability in adults and strong consideration should be given to C1-2 arthrodesis. This procedure can reliably produce good outcomes with minimal morbidity.
炎症性起源的获得性寰枢椎不稳（格里斯尔综合征）是一种罕见病症。它通常发生于患有良性上呼吸道问题的儿童，通过制动治疗效果良好，很少需要进行C1 - 2关节融合术。我们近期对2例成人病例的经验表明，在年龄较大的亚组中情况可能并非如此。
一名71岁男性在血培养阴性的心内膜炎背景下出现C1 - 2不稳。最初尝试制动8周，但新的影像学检查显示齿状突进行性破坏且不稳加重。C1 - 4关节融合术后症状缓解。一名35岁女性在拔除磨牙和患中耳炎后出现C1 - 2不稳。尽管进行了12周的制动和抗生素治疗，症状仍持续存在且寰齿间距增加。她通过C1 - 2关节融合术获得成功治疗。
文献回顾显示，自1830年以来有13篇报道（14例）18岁及以上患者的炎症性寰枢椎不稳。包括此处报告的2例，11例最初接受非手术治疗，其中仅2例（18.2%）获得持久满意效果。在这16例中，仅4例通过抽吸C1 - 2脓肿确诊。少数病例（5/16，31.3%）可见齿状突破坏。在自引入基于螺钉的C1 - 2固定术以来对该主题的首次综述中，表明非手术治疗对成人炎症性寰枢椎不稳无效，应强烈考虑进行C1 - 2关节融合术。该手术能可靠地产生良好效果且并发症最少。
