Iatrogenic atlantoaxial rotatory subluxation after thyroidectomy in a pediatric patient:A case report  

作　　者：Woo-Joon Hong Jung-Kil Lee Jong-Hwan Hong Moon-Soo Han Shin-Seok Lee 

机构地区：[1]Department of Neurosurgery,Chonnam National University Hospital&Medical School,Gwangju 61469,South Korea [2]Department of Rheumatology,Department of Internal Medicine,Chonnam National University Medical School&Hospital,Gwangju 61469,South Korea

出　　处：《World Journal of Clinical Cases》2023年第14期3351-3355,共5页世界临床病例杂志

基　　金：Supported by The Chonnam National University Hospital Biomedical Research Institute,No.BCRI22023。

摘　　要：BACKGROUND 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.CASE SUMMARY 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.CONCLUSION 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.

关 键 词：Atlantoaxial joint Joint subluxation ADOLESCENT Grisel’s syndrome Case report 

分 类 号：R726.5[医药卫生—儿科]