pattismith
Senior Member
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I wonder if post infectious CCI (@JenB @jeff_w ) could fall into the Grisel syndrome (and variants).
Thank you @Daffodil who pointed these case reports.
Here some papers on that topic:
Atlantoaxial Instability of Inflammatory Origin in Adults: Case Reports, Literature Review, and Rationale for Early Surgical Intervention
Article· Literature Review in Neurosurgery 76(2) · September 2014
Abstract
Background and importance: 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. Clinical presentation: 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. Conclusion: 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.
Inflammatory C2-3 subluxation: A Grisel's syndrome variant
Article in Archives of Disease in Childhood 88(7):628-9 · August 2003
Abstract
The concurrence of non-traumatic atlanto-axial subluxation with inflammation of the adjacent neck tissues is known as Grisel's syndrome. We report a 5 year old boy with recurring episodes of head tilt and painful and restricted neck movements that developed after repeated bouts of sinusitis. Radiographs showed a subluxation of the C2-3 joint. Medical treatment, with cervical collar, physiotherapy, and non-steroid anti-inflammatory agents, led to complete cure of the disease. We suggest that Grisel's syndrome can occur in a location different from the classic atlanto-axial joint. To the best of our knowledge, this is the first report of a symptomatic case of Grisel's syndrome occurring at the C2-3 segment.
Midcervical Postinfectious Ligamentous Instability: A Variant of Grisel’s Syndrome
Article in Pediatric Neurosurgery 29(3):133-7 · October 1998
Abstract
We report our recent experience with two cases of C3-C4 ligamentous instability that developed after the onset of an upper airway infection. To our knowledge, this is the first report in the literature of a variant of Grisel's syndrome occurring at the midcervical levels. The diagnosis and management of this entity are presented. Two infants with respiratory distress were evaluated at the Children's Hospital of Buffalo. During evaluation, cervical spine x-rays showed midcervical translational instability. Neither patient had a neurological deficit nor a history of trauma or bone disease. One of the patients was immmobilized with an external orthosis. Each patient remained neurologically intact, and the cervical spine returned to normal alignment after several months. We discuss a possible mechanism for this unusual association and recommend external immobilization.
Thank you @Daffodil who pointed these case reports.
Here some papers on that topic:
Atlantoaxial Instability of Inflammatory Origin in Adults: Case Reports, Literature Review, and Rationale for Early Surgical Intervention
Article· Literature Review in Neurosurgery 76(2) · September 2014
Abstract
Background and importance: 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. Clinical presentation: 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. Conclusion: 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.
Inflammatory C2-3 subluxation: A Grisel's syndrome variant
Article in Archives of Disease in Childhood 88(7):628-9 · August 2003
Abstract
The concurrence of non-traumatic atlanto-axial subluxation with inflammation of the adjacent neck tissues is known as Grisel's syndrome. We report a 5 year old boy with recurring episodes of head tilt and painful and restricted neck movements that developed after repeated bouts of sinusitis. Radiographs showed a subluxation of the C2-3 joint. Medical treatment, with cervical collar, physiotherapy, and non-steroid anti-inflammatory agents, led to complete cure of the disease. We suggest that Grisel's syndrome can occur in a location different from the classic atlanto-axial joint. To the best of our knowledge, this is the first report of a symptomatic case of Grisel's syndrome occurring at the C2-3 segment.
Midcervical Postinfectious Ligamentous Instability: A Variant of Grisel’s Syndrome
Article in Pediatric Neurosurgery 29(3):133-7 · October 1998
Abstract
We report our recent experience with two cases of C3-C4 ligamentous instability that developed after the onset of an upper airway infection. To our knowledge, this is the first report in the literature of a variant of Grisel's syndrome occurring at the midcervical levels. The diagnosis and management of this entity are presented. Two infants with respiratory distress were evaluated at the Children's Hospital of Buffalo. During evaluation, cervical spine x-rays showed midcervical translational instability. Neither patient had a neurological deficit nor a history of trauma or bone disease. One of the patients was immmobilized with an external orthosis. Each patient remained neurologically intact, and the cervical spine returned to normal alignment after several months. We discuss a possible mechanism for this unusual association and recommend external immobilization.
