We thank the authors for their article focusing on pediatric atraumatic atlantoaxial subluxation (1).
This may occur following local infection or surgical intervention within the craniocervical region (Grisel´s syndrome) but also after trauma or without any identifiable cause. Unfortunately the diagnosis is often made late. For the more than 40 subluxations we treated over the past decades the time gap between the occurrence of the subluxation and satisfactory treatment was a mean of 178 days. If the diagnosis is delayed the only remaining therapeutic option is usually surgical revision and fusion of the C1/2 (atlantoaxial) joint, which is of crucial importance for rotation (2).
Recent and still mobile subluxations can be treated by using a direct closed reduction technique: Under short general anesthesia the anterior dislocated lateral mass is palpated transorally at the pharyngeal posterior wall; reduction is performed by slight pressure on the protruded lateral mass assisted by slight derotation and traction at the head.
This approach may spare the children several weeks in halo traction as described in the case example (3).
References
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