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A novel technique to treat Grisel’s syndrome: results of a simplified, therapeutical algorithm

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Abstract

Purpose

Grisel’s syndrome is a rare entity and usually develops in paediatric patients after otolaryngologic surgery or infection. It is defined as a fixed torticollis combined with a rotatory atlanto-axial subluxation. The success rate of physiotherapy is low. Conventional therapy concepts imply stage-related recommendations based on the Fielding classification (type I–IV). This classification was introduced in 1977 to assess the degree of subluxation between atlas (C1) and axis (C2). Thus, instability increases from type I to IV. Higher stages may require surgical intervention. The purpose of this study was to evaluate the value of an alternative, less invasive treatment protocol in Grisel’s syndrome.

Methods

Irrespective of the underlying Fielding type we treated five children (Fielding type I–III) by manual repositioning under general anaesthesia. Consecutively, the cervical spine was immobilized with a Minerva cast for four to eight weeks. Additional surgical treatment or immobilization in a Halo-Fixateur was not necessary.

Results

Overall period of treatment was reduced, even in patients with delayed diagnosis. No case of recurrence was observed within a follow-up of six months.

Conclusions

Current conventional recommendations suggest invasive treatment with Halo-Fixateur in patients with higher degrees of subluxation (e.g., Fielding type III) or after delayed diagnosis. Even in those patients, this novel therapy concept enables us to achieve excellent clinical results without surgical intervention.

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Orthopedics and Sports Medicine, Technische Universität München, Munich, Germany

    Hakan Pilge, Renee Lampe & Peter Michael Prodinger

  2. Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia

    Boris Michael Holzapfel

  3. Department of Anaesthesiology, Helios Clinic Wuppertal, Witten/Herdecke University, Wuppertal, Germany

    Stefanie Pilge

  4. Orthopedic Department, University Hospital Düsseldorf, Düsseldorf, Germany

    Hakan Pilge

Authors
  1. Hakan Pilge
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  2. Boris Michael Holzapfel
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  3. Renee Lampe
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  4. Stefanie Pilge
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  5. Peter Michael Prodinger
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Corresponding author

Correspondence to Hakan Pilge.

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Pilge, H., Holzapfel, B.M., Lampe, R. et al. A novel technique to treat Grisel’s syndrome: results of a simplified, therapeutical algorithm. International Orthopaedics (SICOT) 37, 1307–1313 (2013). https://doi.org/10.1007/s00264-013-1895-4

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  • DOI: https://doi.org/10.1007/s00264-013-1895-4

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