Grisel Syndrome in Pediatric Age: A Single-Center Italian Experience and Review of the Literature

Pasquale Anania, Piero Pavone, Mattia Pacetti, Monica Truffelli, Marco Pavanello, Marcello Ravegnani, Alessandro Consales, Armando Cama, Gianluca Piatelli

Research output: Contribution to journalReview articlepeer-review


BACKGROUND: Nontraumatic atlantoaxial subluxation, also known as Grisel syndrome, is a rare disease that usually affects children. The typical presentation is torticollis in patients with a history of surgical operations or airway infections.

METHODS: We describe 5 patients with Grisel syndrome, referring to medical care for a torticollis, a few weeks after an airway infection, with no trauma associated. Radiologic confirmation of the diagnosis, with computed tomography and magnetic resonance imaging studies, was carried out.

RESULTS: The patients were treated with external immobilization for 3 months, followed by surgical fixation in the case of recurrence after collar removal or inveterate subluxation. We performed a review of the literature to define the best management of this disease.

CONCLUSIONS: Management of Grisel syndrome depends on the degree of subluxation basing on the Fielding and Hawkins classification. The initial nonsurgical management consists of close reduction and immobilization. Surgical fixation is indicated in cases of conservative treatment failure.

Original languageEnglish
Pages (from-to)374-382
Number of pages9
JournalWorld Neurosurg.
Publication statusPublished - May 2019


  • Atlanto-Axial Joint/injuries
  • Child
  • Female
  • Humans
  • Immobilization/instrumentation
  • Joint Dislocations/surgery
  • Male
  • Mycoplasma Infections/complications
  • Mycoplasma pneumoniae
  • Orthopedic Fixation Devices
  • Quality of Life
  • Respiratory Tract Infections/complications
  • Streptococcal Infections/complications
  • Streptococcus pyogenes
  • Syndrome
  • Torticollis/etiology
  • Treatment Outcome


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