Recurrent Torticollis and Cervical Subluxation in a Pediatric Patient

Background: Atlantoaxial subluxation (AAS), also referred to as C1-C2 subluxation, is a misalignment of the first two vertebrae of the cervical spine. AAS typically presents with a head tilt (torticollis) with limited range of motion (ROM). Torticollis is quite common in infants, but in older children, torticollis may be an indication of AAS. Method: In this retrospective case study, the clinical history of a female pediatric patient diagnosed with atlantoaxial subluxation presenting with recurrent torticollis is reviewed. Result: The patient was initially diagnosed with torticollis during infancy; torticollis partially resolved. However, after an ear infection, the child again developed torticollis secondary to Grisel’s Syndrome. Despite undergoing physical therapy treatments, torticollis persisted. The patient was referred to neurosurgery at age nine. AAS was diagnosed after a three-dimensional (3D) computed tomography (CT) scan. The child was subsequently placed in halo-traction to reduce the C1-C2 subluxation. Once the alignment was acceptable, the child was placed in a halo vest. However, even after several months of noninvasive cervical spine immobilization with a halo vest and hard cervical collar, the head tilt and cervical subluxation recurred due to bone remodeling. Conclusion: The diagnosis of AAS requires both a comprehensive physical examination and imaging following presentation of torticollis. Understanding the etiology of the torticollis early on is critical in preventing the occurrence of AAS after treatment.