Spennato Pietro, Nicosia Giancarlo, Rapanà Armando, Cicala Domenico, Donnianni Tiziana, Scala Silvana, Aliberti Ferdinando, Cinalli Giuseppe
Neurosurgery Department, AORN Santobono-Pausilipon-Annunziata Children's Hospital, Naples, Italy.
Neurosurgery Department, AORN Santobono-Pausilipon-Annunziata Children's Hospital, Naples, Italy.
World Neurosurg. 2015 Nov;84(5):1494.e7-12. doi: 10.1016/j.wneu.2015.04.060. Epub 2015 May 7.
Grisel syndrome is a nontraumatic rotatory subluxation of the atlantoaxial joint, following nasopharyngeal inflammation or ear, nose, and throat (ENT) procedures. The syndrome should be suspected in cases of persistent neck pain and stiffness, especially after ENT surgical procedures. The primary treatment of early detected Grisel syndrome is conservative. If conservative treatment fails to achieve a stable reduction or it is followed by neurologic symptoms, arthrodesis of the first and second cervical vertebrae is indicated. We report the case of a 9-year-old boy who developed Grisel syndrome after adenoidectomy and was treated with C1-C3 internal fixation and fusion.
A 9-year-old boy was referred to our hospital with a 3-month history of painful torticollis, which appeared 4 days after adenoidectomy. The patient underwent a neuroimaging study that documented the presence of atlantoaxial rotatory subluxation. The patient underwent C1-C3 internal fixation and fusion, using lateral masses and laminar and pars interarticularis screws. On the third postoperative day he was mobilized with a rigid collar. Postoperative computed tomography scans showed the resolution of rotational deformity and a solid fusion.
Early treatment of Grisel syndrome is of utmost importance to avoid neurologic complications and surgical intervention. In a patient with torticollis following ENT procedures, Grisel syndrome should be always suspected. In case of failure of conservative treatment or in case of delayed diagnosis, rigid C1-C2 or C1-C2-C3 fixation is a straightforward and valid surgical technique, even in children, because it provides immediate spinal stability in all planes at the atlantoaxial complex, avoiding the need for prolonged rigid external bracing.
格里斯尔综合征是一种非创伤性寰枢关节旋转半脱位，继发于鼻咽部炎症或耳鼻喉（ENT）手术后。对于持续颈部疼痛和僵硬的病例，尤其是在耳鼻喉手术后，应怀疑该综合征。早期发现的格里斯尔综合征的主要治疗方法是保守治疗。如果保守治疗未能实现稳定复位或随后出现神经症状，则需进行第一和第二颈椎的关节融合术。我们报告了一例9岁男孩，他在腺样体切除术后发生格里斯尔综合征，并接受了C1-C3内固定融合术治疗。
一名9岁男孩因斜颈疼痛3个月被转诊至我院，斜颈在腺样体切除术后4天出现。患者接受了神经影像学检查，证实存在寰枢关节旋转半脱位。患者采用侧块、椎板和关节突螺钉进行了C1-C3内固定融合术。术后第三天，他佩戴硬质颈托活动。术后计算机断层扫描显示旋转畸形消失且融合牢固。
格里斯尔综合征的早期治疗对于避免神经并发症和手术干预至关重要。对于耳鼻喉手术后出现斜颈的患者，应始终怀疑格里斯尔综合征。在保守治疗失败或诊断延迟的情况下，即使是儿童，C1-C2或C1-C2-C3坚强内固定也是一种直接有效的手术技术，因为它能在寰枢复合体的所有平面立即提供脊柱稳定性，避免了长期使用硬质外部支具的需要。
