医学
外科
斜颈
半脱位
甲状腺切除术
还原(数学)
寰枢椎不稳
医源性损伤
颈椎
甲状腺
替代医学
病理
内科学
几何学
数学
作者
Woo-Joon Hong,Jung-Kil Lee,Jong-Hwan Hong,Moon-Soo Han,Shin‐Seok Lee
出处
期刊:World Journal of Clinical Cases
[Baishideng Publishing Group Co (World Journal of Clinical Cases)]
日期:2023-05-12
卷期号:11 (14): 3351-3355
被引量:1
标识
DOI:10.12998/wjcc.v11.i14.3351
摘要
Atlantoaxial rotatory subluxation (AARS) is an uncommon disease with a greater prevalence among children than adults, and it is mostly associated with trauma. Iatrogenic spinal injury accounts for a low percentage of injuries. However, in AARS, 20%-40% of cases are associated with surgery, and 48% are caused by infection. Here, we describe our experience with a case of iatrogenic AARS after general anesthesia.A 12-year-old girl presented with right-sided torticollis and cervical motion limit. The patient had undergone thyroidectomy 2 mo ago. Computed tomography revealed AARS with bilateral locked facets. Following the failure of repeated external reduction under general anesthesia, the patient underwent an open surgical reduction. The patient gained atlantoaxial alignment without any complications. Follow-up radiographs showed a normal appearance without instability. The cervical spine of children is more predisposed to injury due to anatomical and biomechanical differences. AARS secondary to infection and surgery is known as Grisel's syndrome, which involves non-traumatic AARS. Several cases of AARS after surgery and other procedures with no evidence of inflammation have been reported. Our experience shows that surgery requiring hyperextension of the neck after general anesthesia should also be included as a risk factor.Surgeons and anesthesiologists should be careful not to excessively extend the neck during pediatric surgery. Moreover, clinicians caring for pediatric patients with recent head and neck procedures must be aware of common AARS presentations.
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