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Qu Y, Tian Y, Fang J, Tian Y, Han D, Ren L, Xu N, Wang C, Guo X, Wang S, Han Y. Preoperative radiological indicators for prediction of difficult laryngoscopy in patients with atlantoaxial dislocation. Heliyon 2024; 10:e23435. [PMID: 38148803 PMCID: PMC10750185 DOI: 10.1016/j.heliyon.2023.e23435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 11/30/2023] [Accepted: 12/04/2023] [Indexed: 12/28/2023] Open
Abstract
Background Difficult airway remains a great challenge in patients with atlantoaxial dislocation (AAD). Preoperative evaluation and reliable prediction are required to facilitate the airway management. We aimed to screen out reliable radiological indicators for prediction of difficult laryngoscopy in patients with AAD. Methods A retrospective nested case-control study within a single center longitudinal AAD cohort was conducted to investigate the radiological indicators. All the patients with difficult laryngoscopy from 2010 to 2021 were enrolled as the difficult laryngoscopy group. Others in the cohort without difficult laryngoscopy were randomly selected as the non-difficult laryngoscopy group by individually matching with the same gender, same surgery year, and similar age (±5 years) at a ratio of 6:1. Radiological data on preoperative lateral X-ray images between the two groups were compared. Bivariate logistic regression model was applied to screen out the independent predictive indicators and calculate the odds ratios of indicators associated with difficult laryngoscopy. Receiver operating characteristic curve and area under the curve (AUC) were used to describe the discrimination ability of indicators. Results A total of 154 patients were finally analyzed in this study. Twenty-two patients with difficult laryngoscopy and matched with 132 controls. Four radiological parameters showed significant difference between the two groups. Among which, ΔC1C2D (the difference of the distance between atlas and axis in the neutral and extension position), owned the largest AUC. Conclusions ΔC1C2D could be a valuable radiologic predictor for difficult laryngoscopy in patients with AAD.
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Affiliation(s)
- Yinyin Qu
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Yang Tian
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Jingchao Fang
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Yinglun Tian
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
| | - Dengyang Han
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Linyu Ren
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Nanfang Xu
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
| | - Chao Wang
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
| | - Xiangyang Guo
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Shenglin Wang
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
| | - Yongzheng Han
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
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2
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Al-Hussain OH, Al-Hussain G. Diagnostic Approach and Treatment Options for Pediatric Cases of Grisel's Syndrome Post Otolaryngology Procedure: A Systematic Review. Cureus 2024; 16:e51739. [PMID: 38187032 PMCID: PMC10771032 DOI: 10.7759/cureus.51739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2024] [Indexed: 01/09/2024] Open
Abstract
Grisel's syndrome is an uncommon cervical spine condition marked by non-traumatic rotational subluxation of the atlantoaxial joint. This systematic review aims to collect potential evidence from relevant studies that reported symptoms, diagnostic methods, and management options among pediatric cases of Grisel's syndrome post otolaryngology procedures, which can aid and guide the diagnosis and management in clinical practice. We conducted both electronic and manual search strategies within the potential databases and included case reports, case series, and articles; however, review papers and correspondence papers were excluded. The post-otolaryngology procedures included adenoidectomy, tonsillectomy, tympanoplasty, cochlear implantation, double opposing Z plasty and pharyngeal flap, and adenotonsillectomy. In this systematic review, we identified and analyzed 20 studies encompassing a total of 24 pediatric patients with Grisel's syndrome following otolaryngology procedures. The patient demographics revealed a fairly even distribution between females (45.83%) and males (50.00%), with ages ranging from 2.5 to 12 years. The most common otolaryngology procedures associated with Grisel's syndrome were adenoidectomy (29.17%) and adenotonsillectomy (33.33%). Clinical symptoms included neck pain (75.00%), torticollis (50.00%), and limited neck mobility (20.83%), while diagnostic confirmation primarily relied on CT scans (50.00%). Treatment strategies varied, with conservative measures being the most frequent choice, followed by surgical interventions in four cases (16.67%). Complications were reported in 20.83% of cases. Due to the rarity of this condition, our findings are limited to case reports only, which may limit the generalizability of results. Grisel syndrome can be effectively managed through conservative treatment, including antibiotics and anti-inflammatory drugs if diagnosed timely. Early diagnosis and prompt management are essential to avoid neurological and fatal complications. This analysis would contribute to improving clinical knowledge and treatment strategies while providing additional insights into this rare condition.
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Affiliation(s)
- Omair H Al-Hussain
- Otolaryngology - Head and Neck Surgery, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
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3
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Abdul Latiff A, Muhamad Ariffin MH, Kumar N. Successful Cases of Closed Reduction of Chronic Traumatic Atlantoaxial Rotatory Dislocation: A Report of Two Cases. Cureus 2023; 15:e36445. [PMID: 37090403 PMCID: PMC10115666 DOI: 10.7759/cureus.36445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 04/25/2023] Open
Abstract
We report two cases of children with atlantoaxial rotatory dislocation (AARD) post-trauma with a chronic history of persistent neck pain and torticollis. The neurological examinations were normal. The dislocation reduction was challenging; however, cases with such delayed presentation, treated with closed reduction and external stabilization, are rare. After reduction, a serial CT scan during follow-up showed no recurrence.
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Affiliation(s)
- Afif Abdul Latiff
- Orthopaedics and Traumatology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MYS
| | | | - Navin Kumar
- Orthopaedics and Traumatology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MYS
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4
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Aldamouni MB, Albitar MH, Alhosainy ZH, Aljohani HN, Alshail E. Challenges in Grisel's Syndrome Management in a Two-Month-Old Infant. Cureus 2023; 15:e35128. [PMID: 36950002 PMCID: PMC10027574 DOI: 10.7759/cureus.35128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2023] [Indexed: 02/20/2023] Open
Abstract
Grisel's syndrome (GS) is a rare neurosurgical condition involving nontraumatic rotatory subluxation of the atlantoaxial joint. This case report presents a two-month-old infant girl, the youngest reported case of this syndrome based on our literature review to the date of this publication. The infant was initially referred to our hospital as a case of the arachnoid cyst but was subsequently neuroradiologically diagnosed with GS, which was believed to be secondary to a retropharyngeal abscess. After developing weakness and developmental delay as well as failing conservative management for two years, the infant underwent C1 laminectomy and occipitocervical sublaminar wire fusion with favorable outcomes. GS should be considered a differential even if the patient does not present with typical signs such as torticollis and neck pain. If not identified early and treated effectively, it can result in severe neurological damage. The management plan largely depends on the Fielding-Hawkins grade of subluxation and the timing of diagnosis.
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Affiliation(s)
- Maeen B Aldamouni
- Department of Neurosurgery, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
- College of Medicine, Alfaisal University, Riyadh, SAU
| | | | | | - Hanan N Aljohani
- Department of Neurosurgery, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | - Essam Alshail
- Department of Neurosurgery, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
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5
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Roohollahi F, Iranmehr A, Fatahi Andabili E. A case of atlantoaxial instability following skull base osteomyelitis: Tips for diagnosis and management. Clin Case Rep 2022; 10:e6744. [PMID: 36583201 PMCID: PMC9792648 DOI: 10.1002/ccr3.6744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/25/2022] [Accepted: 12/01/2022] [Indexed: 12/28/2022] Open
Abstract
Skull base osteomyelitis is a rare but dangerous consequence of untreated malignant otitis externa. Pseudomonas aeruginosa is responsible for most cases with typical presentation. Here, we discuss a diabetic 54-year-old female presented with malignant otitis externa and bilateral facial paresis followed by cervical spondylitis and C1-C2 instability. Skull base osteomyelitis confirmed by clinical presentation, imaging, and laboratory data. Fortunately, she responded well to antibacterial and antifungal therapy. Due to limited data, there is no confirmed standard of treatment for cervical instability secondary to SBO. It seems antibiotic therapy is the mainstay of treatment. In case of poor response to antibiotic therapy, surgical intervention is inevitable. This article introduces the first case of SBO-related AAI successfully managed with conservative treatment.
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Affiliation(s)
- Faramarz Roohollahi
- Neurological Surgery Department, Shariati Hospital ComplexTehran University of Medical SciencesTehranIran
| | - Arad Iranmehr
- Neurological Surgery Department, Imam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
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Ghodke A, Gadkari A, Trivedi R, Tikoo A, Chaddha R. Torticollis in an 8-year-old child due to Grisel’s syndrome - A case report. Surg Neurol Int 2022; 13:502. [DOI: 10.25259/sni_805_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 09/20/2022] [Indexed: 11/06/2022] Open
Abstract
Background:
Grisel’s syndrome is a nontraumatic atlantoaxial subluxation resulting from an ongoing local inflammatory process.
Case Description:
An 8-year-old male presented to the emergency department with neck pain which was sudden in onset without any history of any significant fall or trauma. On physical examination, the patient had torticollis with a head tilt to the left side and the chin rotated to the right. The CT scan confirmed atlantoaxial subluxation with C1 rotated to the right on the odontoid process without anterior displacement. The patient was managed conservatively with antibiotics, anti-inflammatory agents, and head-halter traction.
Conclusion:
As Grisel’s syndrome can have catastrophic outcomes, early diagnosis and treatment are critical. It must be considered in patients presenting with acute torticollis following an infection or prior surgery.
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Affiliation(s)
- Aashish Ghodke
- Department of Spine Surgery, Robert Jones and Agnes Hunt Orthopaedic Hospital, England, United Kingdom,
| | - Alok Gadkari
- Department of Spine Surgery, Robert Jones and Agnes Hunt Orthopaedic Hospital, England, United Kingdom,
| | - Rishi Trivedi
- Department of Spine Surgery, Robert Jones and Agnes Hunt Orthopaedic Hospital, England, United Kingdom,
| | - Agnivesh Tikoo
- Department of Spine Surgery, Apollo Hospital, Mumbai, Maharashtra, India
| | - Ram Chaddha
- Department of Spine Surgery, Apollo Hospital, Mumbai, Maharashtra, India
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7
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Štulík J, Rybárová M, Barna M, Klézl Z. Atlantoaxial rotatory dislocation: Surgical treatment in a pediatric patient cohort. BRAIN & SPINE 2022; 2:101667. [PMID: 36506286 PMCID: PMC9729819 DOI: 10.1016/j.bas.2022.101667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 07/20/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022]
Abstract
•Surgical correction of AARD is an appropriate method of treatment after failed non-operative therapy.•The technique of surgical reduction and C1-C2 fixation using Harms/Goel technique provides excellent clinical outcomes.•In case of traumatic AARD we recommend to consider temporary fixation.
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8
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Muacevic A, Adler JR, ALMohammed AA, Alotaibi AM, Surur S. Surgical Treatment of Irreducible AcuteTraumatic Atlantoaxial Rotatory Subluxation in an Adult. Cureus 2022; 14:e31678. [PMID: 36545162 PMCID: PMC9762917 DOI: 10.7759/cureus.31678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2022] [Indexed: 11/20/2022] Open
Abstract
Traumatic atlantoaxial rotatory subluxation (AARS) is a condition that is extremely rare in adults when compared to the pediatric population. The most common symptoms of this condition are torticollis and post-traumatic neck pain. Our patient is a 41-year-old male who presented to the emergency room within hours of the injury. He came by himself with his relative as a case of road traffic accident. He was the first passenger and had been restrained during the car accident, with no ejection or rollover. He presented with stiffness/pain and reduced range of motion in the neck. Computed tomography (CT) of the cervical spine showed rotatory subluxation of C1 over the C2 with a locked facet. Within 24 hours of the RTA and patient admission, we attempted cervical traction. The reduction was not successful. So, we decided to reduce AARS through a surgical approach. The patient was taken to the operating room for open reduction and fixation using the Harms technique for C1-C2 fusion. The patient recovered from the surgery uneventfully, without any complications, recovered cervical mobility, and improved torticollis. Surgical management through open reduction and internal fixation is recommended for AARD cases in which close reduction fails due to a locked facet.
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9
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González DCN, Ardura Aragón F, Sanjuan JC, Maniega SS, Andrino AL, García Fraile R, Labrador Hernández G, Calabia-Campo J, Caballero-García A, Córdova-Martínez A. C1-C2 Rotatory Subluxation in Adults “A Narrative Review”. Diagnostics (Basel) 2022; 12:diagnostics12071615. [PMID: 35885520 PMCID: PMC9316247 DOI: 10.3390/diagnostics12071615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 11/28/2022] Open
Abstract
The atlantoaxial joint C2 (axis) with the anterior arch of C1 (atlas) allows 50% of cervical lateral rotation. It is responsible for precise and important movements that allow us to perform precise actions, both in normal and working life. Due to low incidence in adults, this condition often goes undiagnosed, or the diagnosis is delayed and the outcome is worse. An early diagnosis and treatment are essential to ensure satisfactory neurological and functional outcomes. The aim of this review is to analyze C1-C2 rotatory subluxation in adults, given its rarity. The time between injury and reduction is key, as it is directly related to prognosis and the severity of the treatment options. Due to low incidence in adults, this condition often goes undiagnosed, or the diagnosis is delayed as a lot of cases are not related to a clear trauma, with a poor prognosis just because of the late diagnosis and the outcome is worse. The correct approach and treatment of atlantoaxial dislocation requires a careful study of the radiological findings to decide the direction and plane of the dislocation, and the search for associated skeletal anomalies.
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Affiliation(s)
- David C. Noriega González
- Department of Surgery, Ophthalmology, Otorhinolaryngology and Physiotherapy, Faculty of Medicine, University of Valladolid, 47005 Valladolid, Spain; (D.C.N.G.); (F.A.A.)
| | - Francisco Ardura Aragón
- Department of Surgery, Ophthalmology, Otorhinolaryngology and Physiotherapy, Faculty of Medicine, University of Valladolid, 47005 Valladolid, Spain; (D.C.N.G.); (F.A.A.)
- Department of Orthopedic, Clinic University Hospital of Valladolid, 47005 Valladolid, Spain; (J.C.S.); (S.S.M.); (A.L.A.); (R.G.F.); (G.L.H.)
| | - Jesús Crespo Sanjuan
- Department of Orthopedic, Clinic University Hospital of Valladolid, 47005 Valladolid, Spain; (J.C.S.); (S.S.M.); (A.L.A.); (R.G.F.); (G.L.H.)
| | - Silvia Santiago Maniega
- Department of Orthopedic, Clinic University Hospital of Valladolid, 47005 Valladolid, Spain; (J.C.S.); (S.S.M.); (A.L.A.); (R.G.F.); (G.L.H.)
| | - Alejandro León Andrino
- Department of Orthopedic, Clinic University Hospital of Valladolid, 47005 Valladolid, Spain; (J.C.S.); (S.S.M.); (A.L.A.); (R.G.F.); (G.L.H.)
| | - Rubén García Fraile
- Department of Orthopedic, Clinic University Hospital of Valladolid, 47005 Valladolid, Spain; (J.C.S.); (S.S.M.); (A.L.A.); (R.G.F.); (G.L.H.)
| | - Gregorio Labrador Hernández
- Department of Orthopedic, Clinic University Hospital of Valladolid, 47005 Valladolid, Spain; (J.C.S.); (S.S.M.); (A.L.A.); (R.G.F.); (G.L.H.)
| | - Juan Calabia-Campo
- Department of Radiology, Clinic University Hospital of Valladolid, 47005 Valladolid, Spain;
| | - Alberto Caballero-García
- Department of Anatomy and Radiology, Health Sciences Faculty, GIR: “Physical Exercise and Aging”, University of Valladolid, Campus Universitario “Los Pajaritos”, 42004 Soria, Spain;
| | - Alfredo Córdova-Martínez
- Department of Biochemistry, Molecular Biology and Physiology, Health Sciences Faculty, GIR: “Physical Exercise and Aging”, University of Valladolid, Campus Universitario “Los Pajaritos”, 42004 Soria, Spain
- Correspondence:
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10
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Alkhaldi A, Alwadi F, Alenezi M, Alshammari J. Hyaluronic acid augmentation pharyngoplasty complicated by retropharyngeal abscess and grisel syndrome: Case report and literature review. Clin Case Rep 2022; 10:e05901. [PMID: 35600025 PMCID: PMC9122795 DOI: 10.1002/ccr3.5901] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/23/2022] [Accepted: 05/01/2022] [Indexed: 11/10/2022] Open
Abstract
Augmentation pharyngoplasty, in which tissue filler or grafts are used to augment the posterior nasopharynx, is an accepted option to treat velopharyngeal insufficiency. It is generally well tolerated and safe with limited side effects. In this study, we describe a case of a retropharyngeal abscess and Grisel syndrome following hyaluronic acid augmentation pharyngoplasty. Grisel syndrome is a serious condition that requires early diagnosis and prompt intervention to prevent further complications. Velopharyngeal insufficiency (VPI) can be treated conservatively by speech therapy or surgically by augmentation pharyngoplasty and pharyngeal surgeries. Augmentation pharyngoplasty is safe and well‐tolerated procedure. We report a very rare complication of this procedure which is retropharyngeal abscess and Grisel syndrome (GS). GS is a serious condition that requires early diagnosis and prompt intervention to prevent further neurological complications.
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Affiliation(s)
- Abdullah Alkhaldi
- Otolaryngology Head & Neck Surgery King Abdullah Specialized Children Hospital King Abdulaziz Medical City National Guard Health Affairs Riyadh Saudi Arabia.,King Abdullah International Medical Research Center Riyadh Saudi Arabia
| | - Fahad Alwadi
- Otolaryngology Head & Neck Surgery King Abdullah Specialized Children Hospital King Abdulaziz Medical City National Guard Health Affairs Riyadh Saudi Arabia.,King Abdullah International Medical Research Center Riyadh Saudi Arabia
| | - Mazyad Alenezi
- Department of Otolaryngology Head and Neck Surgery College of Medicine Qassim University Qassim Saudi Arabia
| | - Jaber Alshammari
- Otolaryngology Head & Neck Surgery King Abdullah Specialized Children Hospital King Abdulaziz Medical City National Guard Health Affairs Riyadh Saudi Arabia.,King Abdullah International Medical Research Center Riyadh Saudi Arabia
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11
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Macki M, Pawloski J, Fadel HA, Abdulhak MM. Surgical management of Grisel syndrome in the adult patient: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022; 3:CASE21692. [PMID: 36130538 PMCID: PMC9379629 DOI: 10.3171/case21692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 01/03/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Grisel syndrome describes an infectious soft tissue process that destabilizes the cervical bony elements and ligamentous complexes. This nontraumatic atlantoaxial rotary subluxation occurs in children primarily. This case illustrates a rare case presentation of an adult with Grisel syndrome: infectious destruction of the right atlantoaxial facet joint caused the occiput-C1 vertebra (head) to rotate rightward with lateral horizontal displacement off the C2 vertebra. OBSERVATIONS Because the infection destroyed the C1 bony arch and atlantoaxial facet joints with epidural extension, the rotated head and atlas pulled the brainstem–cervical spinal cord junction against a fixed odontoid process, resulting in a cord contusion. Because of the highly unstable craniocervical junction, the patient presented with torticollis and left upper extremity weakness. LESSONS Treatment entailed closed reduction under general anesthesia followed by occipitocervical fusion with an occipital plate, C1 lateral mass screws, and C2-C5 pedicle screws. This case describes the unique surgical pearls necessary for occipitocervical fusion of an unstable craniocervical junction, including tips with neuronavigation, trajectories of the cervical pedicle screws, aligning the lateral mass and pedicle screws with the occipital plate, and nuances with occipitocervical distraction.
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Affiliation(s)
- Mohamed Macki
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan
| | - Jacob Pawloski
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan
| | - Hassan A. Fadel
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan
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12
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Atlantoaxial Rotatory Fixation after Microtia Reconstruction Surgery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3760. [PMID: 34476155 PMCID: PMC8382324 DOI: 10.1097/gox.0000000000003760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 06/22/2021] [Indexed: 11/26/2022]
Abstract
Nontraumatic atlantoaxial rotatory fixation after microtia reconstruction surgery is a rare complication. Intraoperative cervical hyperextension and/or excessive rotation and postoperative inflammation have been reported as causes of atlantoaxial rotatory fixation. We herein describe cases of atlantoaxial rotatory fixation after microtia reconstruction surgery. Methods This was a retrospective study of 80 patients (165 surgeries) who underwent microtia reconstruction surgery in Dokkyo Medical University Hospital between April 2006 and December 2012. The patient- and operation-related variables were obtained from medical charts. Neck radiographs and computed tomography scans of patients with atlantoaxial rotatory fixation were evaluated to check for cervical spine abnormalities. Results Five cases of atlantoaxial rotatory fixation after microtia reconstruction surgery were recorded. Three of these five cases were diagnosed with Klippel-Feil syndrome after the onset of atlantoaxial rotatory fixation. No significant difference was found in the operative duration and other variables between patients with atlantoaxial rotatory fixation and those without. All patients immediately underwent conservative treatment and showed complete recovery and no recurrences. Conclusions Although atlantoaxial rotatory fixation is a rare complication, surgeons should consider it in patients with neck problems following microtia reconstruction surgery. A patient with microtia may have unrecognized Klippel-Feil syndrome. Patients with Klippel-Feil syndrome are more likely to develop atlantoaxial rotatory fixation, which may have severe consequences. Thus, it is crucial to preoperatively identify Klippel-Feil syndrome with neck radiography and to detect atlantoaxial rotatory fixation at the earliest.
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13
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Wenger KJ, Hattingen E, Porto L. Magnetic Resonance Imaging as the Primary Imaging Modality in Children Presenting with Inflammatory Nontraumatic Atlantoaxial Rotatory Subluxation. CHILDREN-BASEL 2021; 8:children8050329. [PMID: 33922701 PMCID: PMC8144996 DOI: 10.3390/children8050329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/15/2021] [Accepted: 04/20/2021] [Indexed: 11/16/2022]
Abstract
Inflammatory nontraumatic atlantoaxial rotatory subluxation (AAS) in children is an often-missed diagnosis, especially in the early stages of disease. Abscess formation and spinal cord compression are serious risks that call for immediate surgical attention. Neither radiographs nor non-enhanced computed tomography (CT) images sufficiently indicate inflammatory processes. Magnetic resonance imaging (MRI) allows a thorough evaluation of paraspinal soft tissues, joints, and ligaments. In addition, it can show evidence of vertebral distraction and spinal cord compression. After conducting a scoping review of the literature, along with scientific and practical considerations, we outlined a standardized pediatric MRI protocol for suspected inflammatory nontraumatic AAS. We recommend contrast-enhanced MRI as the primary diagnostic imaging modality in children with signs of torticollis in combination with nasopharyngeal inflammatory or ear nose and throat (ENT) surgical history.
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14
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Spinnato P, Zarantonello P, Guerri S, Barakat M, Carpenzano M, Vara G, Bartoloni A, Gasbarrini A, Molinari M, Tedesco G. Atlantoaxial rotatory subluxation/fixation and Grisel's syndrome in children: clinical and radiological prognostic factors. Eur J Pediatr 2021; 180:441-447. [PMID: 33064218 DOI: 10.1007/s00431-020-03836-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 09/25/2020] [Accepted: 10/09/2020] [Indexed: 11/30/2022]
Abstract
Atlantoaxial rotatory subluxation/fixation (AARS/F) is a rare cause of torticollis in children. The aim of our study is to investigate all possible clinical and radiological prognostic factors in children with AARS/F. We retrospectively reviewed all cervical spine CT scans of children with AARS/F treated in our Hospital over the last 15 years. AARS/F was classified according to Fielding and Hawkins classification and C1-C2 rotation-degree was calculated. Moreover, two orthopedic surgeons reviewed all clinical reports of these children. All patients were conservatively treated (cervical traction/neck collar). An early recovery was considered in patients with complete clinical/radiological healing at 3 months follow-up, while a late recovery was considered in patients with disease persistence or relapse at 3 months follow-up or earlier. Fifty-five patients with diagnosis of AARS/F were included in the study (mean age = 8.5 years old - 25F, 30M). In 9/55 subjects (16.4%), a late recovery was observed. The presence of a concomitant infection or inflammation in the head and neck region (Grisel's syndrome) was significantly associated with a late recovery (p < .001). Also, the type of AARS/F (p = .019), according to the Fielding and Hawkins classification, and C1-C2 rotation-degree (p = .027) were significantly correlated with the recovery time.Conclusion: In patients with AARS/F, the presence of a concomitant infection/inflammation in the head and neck region is the most important prognostic factor and it is associated with a late recovery. The Fielding and Hawkins classification and C1-C2 rotation-degree well correlate with patients' recovery time. What is Known: • Atlantoaxial rotatory subluxation/fixation (AARS/F) is a rare cause of torticollis in children and CT is the most useful imaging tool for diagnosis and classification of AARS/F. • Conservative treatments are effective in the majority of pediatric patients with AARS/F. What is New: • The presence of a concomitant infection/inflammation in the head and neck region associated with AARS/F (Grisel's syndrome) is the most important prognostic factor and it is associated with a late recovery. • C1-C2 rotation-degrees, as well as Fielding and Hawkins classification system, well correlate with patients' recovery time.
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Affiliation(s)
- Paolo Spinnato
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via GC Pupilli n 1, 40136, Bologna, Italy.
| | - Paola Zarantonello
- Department of Pediatric Orthopaedics and Traumatology, IRCCS Istituto Ortopedico, Rizzoli, Bologna, Italy
| | - Sara Guerri
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via GC Pupilli n 1, 40136, Bologna, Italy
| | - Massimo Barakat
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via GC Pupilli n 1, 40136, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Maria Carpenzano
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via GC Pupilli n 1, 40136, Bologna, Italy
| | - Giulio Vara
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via GC Pupilli n 1, 40136, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy
| | | | - Alessandro Gasbarrini
- Department of Oncologic and Degenerative Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Massimo Molinari
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via GC Pupilli n 1, 40136, Bologna, Italy
| | - Giuseppe Tedesco
- Department of Oncologic and Degenerative Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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15
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Talbot AM, Rodrigues M, Maddox TW. Computed tomography identified mineralisation of the longitudinal odontoid ligament of the horse is associated with age and sex but not with the clinical sign of head shaking. Vet Radiol Ultrasound 2021; 62:289-298. [PMID: 33385302 DOI: 10.1111/vru.12947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 11/27/2020] [Accepted: 11/27/2020] [Indexed: 11/29/2022] Open
Abstract
Mineralisation of the longitudinal odontoid ligament has recently been identified in three horses undergoing computed tomographic (CT) examination, but published studies describing the clinical relevance of this finding are currently lacking. The objective of this retrospective, analytical, cross-sectional study was to investigate the relationship of this image finding to primary presenting complaint, age, breed, use and sex of the patient, and determine any association to the clinical signs of head shaking, neck pain or restricted range of neck motion. Computed tomographic images of 96 horses undergoing examination of the head and cranial cervical spine, for a variety of clinical reasons, were assessed for the presence of mineralisation within the longitudinal odontoid ligament. Clinical records were reviewed; presenting problem, signalment, clinical signs and final diagnoses were recorded and potential associations of presenting primary problem, signalment and individual clinical signs with mineralisation in the longitudinal odontoid ligament investigated, using univariable and multivariable ordinal logistic regression analysis. Final multivariable analysis confirmed significant associations of increasing severity of mineralisation with increasing age (P = .002) and being female (P = .038). There was no association of mineralisation of the longitudinal odontoid ligament with the syndrome of idiopathic head shaking or other clinical signs investigated in this sample of horses. Authors therefore recommend that the clinical significance of mineralisation of the longitudinal odontoid ligament be interpreted cautiously for equine CT studies.
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Affiliation(s)
- Alison M Talbot
- Equine Hospital, University of Liverpool, Leahurst Campus, Neston, UK
| | - Miguel Rodrigues
- Equine Hospital, University of Liverpool, Leahurst Campus, Neston, UK
| | - Thomas W Maddox
- Small Animal Teaching Hospital, University of Liverpool, Leahurst Campus, Neston, UK
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16
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Grisel's Syndrome in Children: Two Case Reports and Systematic Review of the Literature. Case Rep Pediatr 2020; 2020:8819758. [PMID: 33274097 PMCID: PMC7676959 DOI: 10.1155/2020/8819758] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/20/2020] [Indexed: 11/25/2022] Open
Abstract
Background and Objective. Grisel's syndrome is a rare syndrome characterized by nontraumatic rotatory subluxation of the atlantoaxial joint. It usually affects children and typically presents with torticollis after ear, nose, and throat (ENT) surgery or head and neck infections. In the pediatric literature, there is only a small amount of available data; moreover, no systematic review has been previously done with focus on the pediatric population. We report our experience of two cases, and we provide a systematic review on Grisel's syndrome in children in order to offer a deeper insight about its clinical presentation, its current diagnosis, and principles of treatment. Case Reports and Review. We describe two boys of 9 and 8 years old, who developed atlantoaxial subluxation after adenoidectomy. Considering the early diagnosis, a conservative treatment was chosen, with no recurrence and no sequelae at follow-up. We identified 114 case reports, of which 90 describe children, for a total of 171 pediatric patients. Of the 154 cases in which cause was reported, 59.7% presented a head and neck infection and 35.7% had previous head and neck surgery. There is no sex prevalence (49.7% males versus 50.2% females). Mean delay in diagnosis is 33 days. Eight % of the patients had neurological impairment of the 165 cases which mentioned treatment, 96% underwent a conservative treatment, of whom the 8.8% recurred with the need of surgery. As a whole, 12% underwent surgery as a first- or second-line treatment. 3 6% of the patients whose follow-up was reported developed a sequela, minor limitation of neck movement being the most frequent. Conclusion. Grisel's syndrome should be suspected in children with painful unresponsive torticollis following ENT procedures or head and neck inflammation. CT scan with 3D reconstruction is the gold standard for diagnosis, allowing the identification of the subluxation and the classification according to the Fielding–Hawkins grading system. Surgical treatment is indicated in case of high-grade instability or failure of conservative treatment. Review of the literature shows how early diagnosis based on clinical and radiological evaluation is crucial in order to avoid surgical treatment and neurologic sequelae.
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Patel F, Benjamin JS, Gadiwala S. Acute Torticollis in a 3-year-old Child: Think Outside the Neck. Pediatr Rev 2020; 41:596-598. [PMID: 33139413 DOI: 10.1542/pir.2018-0349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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18
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Tobing SDAL, Abubakar I, Karda IWAM. Recurrent traumatic atlantoaxial rotatory subluxation: Case report. Ann Med Surg (Lond) 2020; 54:65-70. [PMID: 32382411 PMCID: PMC7198983 DOI: 10.1016/j.amsu.2020.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 04/01/2020] [Accepted: 04/10/2020] [Indexed: 12/03/2022] Open
Abstract
Introduction Atlantoaxial rotatory subluxation (AARS) is not uncommon in paediatric emergencies, however, the complications might be fatal. Long onset before presentation is correlated with higher recurrence and persistent deformity. There is no consensus on the treatment of AARS yet. Selected patients may benefit from conservative approaches; however, retention might be difficult, and subluxation may recur. Presentation of case A 6-year-old boy was admitted to our institution with AARS for three months before admission. Typical Cock-Robin position was observed. Computed tomography (CT) indicated AARS Fielding and Hawkins grade III. We treated the case conservatively by closed reduction and cervical traction using Gardner-Wells tongs. However, poor compliance resulted recurrence of subluxation, so we decided to fuse the atlantoaxial joint using transarticular screws, posterior wiring, and autologous bone grafting. Posterior fusion resulted in a satisfactory outcome, in which the wound healed accordingly. Six months of follow up examination revealed normal motoric and sensory function. The patient was able to perform daily activities with no significant issues. Discussion Patients with fixed deformity of more than three weeks have a higher rate for recurrence or persistent deformity, as reduction is harder and difficult to maintain. The use of posterior wiring alone is limited in maintaining reduction, while using transarticular screws alone is considered better in maintaining reduction; however, not providing it. Conclusion The use of posterior cervical fusion using C-wire, transarticular screws, and autologous bone grafting may be applied in recurrent case of AARS to ensure adequate reduction and fixation of the atlantoaxial joint. AARS is not uncommon in the paediatric setting as the biomechanical property of the paediatric spine introduces more risk for dislocation. A 6-year-old boy was admitted with AARS for three months before admission. After treated conservatively, the subluxation reoccurred. We decided to fuse the atlantoaxial joint. Posterior cervical fusion using C-wire, transarticular screws, and autologous bone grafting may be applied in recurrent case of AARS to ensure adequate reduction and fixation of the atlantoaxial joint.
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Affiliation(s)
- Singkat Dohar Apul Lumban Tobing
- Department of Orthopaedics and Traumatology, Cipto Mangunkusumo General Hospital – Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Irsan Abubakar
- Department of Orthopaedics and Traumatology, Cipto Mangunkusumo General Hospital – Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
- Department of Orthopaedics and Traumatology, University of Syiah Kuala, Aceh, Indonesia
| | - I Wayan Arya Mahendra Karda
- Department of Orthopaedics and Traumatology, Cipto Mangunkusumo General Hospital – Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
- Corresponding author. Jalan Diponegoro No. 71, Central Jakarta, Jakarta, 10430, Indonesia.
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19
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Chryssikos T, Pratt N, Howie B, Mushlin H, Sansur C. Open Reduction and Decompression of Atlantoaxial Subluxation with Basilar Impression Due to Grisel Syndrome Using the Cervical Management Base Unit. World Neurosurg 2020; 138:129-136. [PMID: 32147559 DOI: 10.1016/j.wneu.2020.02.165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Intraoperative manipulation of the craniocervical junction with the Cervical Management Base Unit (CMBU) has been used as an adjunct for achieving optimal anatomic alignment during instrumented fusion procedures in a variety of disease settings. Here, we present our experience using the CMBU as a supplement to achieving a successful reduction and fixation of a reducible craniocervical subluxation with associated basilar impression/medullary compression in the setting of Grisel syndrome. CASE DESCRIPTION Under fluoroscopy and neuromonitoring guidance, the elevator and axial translation mechanisms of the CMBU safely allowed for presurgical assessment of reducibility and facilitated complete reduction of the deformity with restitution of a normal atlantodental interval, spinolaminar line, and clivoaxial angle. Magnetic resonance imaging acquired 1 month after surgery and antibiotic therapy showed resolution of a large epidural abscess in the region of the dens and no evidence of residual neural impingement. Upright plain films at 9 months showed maintenance of the desired craniocervical alignment. CONCLUSIONS Intraoperative manipulation of the craniocervical junction using the CMBU, when implemented under fluoroscopy and neuromonitoring, can safely facilitate an enduring anatomic correction of craniocervical deformity in the setting of Grisel syndrome. The dynamic utility of the CMBU for translation of the head and neck obviated the need to apply forces directly to hardware-bone interfaces, and its utility may extend to craniocervical disorders of other etiologies, especially those of a reducible nature and in the setting of poor bone quality and joint laxity.
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Affiliation(s)
- Timothy Chryssikos
- Department of Neurosurgery, University of Maryland, Baltimore, Maryland, USA.
| | - Nathan Pratt
- Department of Neurosurgery, University of Maryland, Baltimore, Maryland, USA
| | - Benjamin Howie
- Department of Neurosurgery, University of Maryland, Baltimore, Maryland, USA
| | - Harry Mushlin
- Department of Neurosurgery, University of Maryland, Baltimore, Maryland, USA
| | - Charles Sansur
- Department of Neurosurgery, University of Maryland, Baltimore, Maryland, USA
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20
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Cucuzza ME, D'Ambra A, Evola FR, Greco F, Smilari P. Grisel syndrome, sigmoid sinus thrombosis and rheumatic carditis: Case report of a rare association. Int J Pediatr Otorhinolaryngol 2020; 129:109774. [PMID: 31734565 DOI: 10.1016/j.ijporl.2019.109774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/04/2019] [Accepted: 11/04/2019] [Indexed: 12/01/2022]
Abstract
Grisel's syndrome (GS) is a non traumatic atlanto-axial rotatory subluxation of C1-C2 joint. A six year old girl, 20 days after an episode of fever, developed a torticollis and a 3/6 heart murmur. The echocardiography showed a Rheumatic Carditis. The Brain and cervical spine Magnetic resonance imaging (MRI) and the Computerized Tomography (CT) showed rotary dislocation of C1-C2 vertebrae, compatible with GS, and cerebral venous thrombosis (CVT). An antibiotic therapy, Prednisone and a low molecular weight heparin for 7 days was prescribedfollowed by an oral anticoagulant for 6 months. After a month the MRI showed a reduction of the dislocation and cerebral venous recanalization.
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Affiliation(s)
- Maria Elena Cucuzza
- Pediatric Clinic, Departmente of Clinical and Experimental Medicine, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy.
| | - Angela D'Ambra
- Pediatric Clinic, Departmente of Clinical and Experimental Medicine, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | | | - Filippo Greco
- Pediatric Clinic, Departmente of Clinical and Experimental Medicine, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Pierluigi Smilari
- Pediatric Clinic, Departmente of Clinical and Experimental Medicine, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
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21
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Andermatten JA, Elua Pinin A, Samprón Lebed N, Armendariz Guezala M, Arrazola Schlamilch M, Úrculo Bareño E. Atlantoaxial subluxation secondary to retropharyngeal abcess in adults (Grisel's syndrome). Review of literature about a clinical case. Neurocirugia (Astur) 2019; 31:201-205. [PMID: 31615691 DOI: 10.1016/j.neucir.2019.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 07/06/2019] [Accepted: 08/06/2019] [Indexed: 10/25/2022]
Abstract
Grisel syndrome (GS) is a non-traumatic atlanto-axial subluxation produced after an inflammatory, infectious or postsurgical process of the upper neck region. It is a characteristic, although currently uncommon complication of acute bacterial pharyngitis in the pediatric age. Presentation in adults is even more infrequent and requires specific management. We present the case of a 68-year-old patient with a history of chronic myeloid leukemia, who presented with infectious polyarthritis, cervicalgia, torticollis and cervical impotence. Cervical radiography, CT, and MRI showed a C1-C2 subluxation adjacent to a pharyngeal abscess, so GS was diagnosed. After antibiotic therapy, the patient had to undergo surgery due to the failure of the closed reduction. Due to its low incidence, there are no clinical guidelines for the management of these patients; The interdisciplinary collaboration is fundamental to establish the opportune diagnosis that allows to establish the conservative treatment and prevent the surgery, as well as the complications and sequelae of the fixation of the atlanto-axial joint.
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Affiliation(s)
| | - Alejando Elua Pinin
- Servicio de Neurocirugía, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, España
| | - Nicolás Samprón Lebed
- Servicio de Neurocirugía, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, España
| | | | | | - Enrique Úrculo Bareño
- Servicio de Neurocirugía, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, España
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22
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Hannonen J, Perhomaa M, Salokorpi N, Serlo W, Sequeiros RB, Sinikumpu J. Interventional magnetic resonance imaging as a diagnostic and therapeutic method in treating acute pediatric atlantoaxial rotatory subluxation. Exp Ther Med 2019; 18:18-24. [PMID: 31258633 DOI: 10.3892/etm.2019.7565] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 02/21/2019] [Indexed: 11/05/2022] Open
Abstract
Atlantoaxial rotatory subluxation or fixation (AARF) is a rare condition, usually occurring in pediatric patients. It mimics benign torticollis but may result in permanent disability or death. The condition requires prompt diagnosis by thorough examination to avoid any treatment delays. Spiral computed tomography (CT) with three-dimensional reconstruction CT is recommended for identifying incongruence between C1 and C2 vertebrae, and magnetic resonance imaging (MRI) may be performed to exclude ligamentous injuries. In addition to static imaging, dynamic CT involves the reduction between C1 and C2 being confirmed using CT with the head turned maximally to the left and right. The present report (level of evidence, III) provides a method for treating AARF that has similar advantages as dynamic CT but avoids ionizing radiation by replacing CT with interventional MRI. The new method comprised simultaneous axial traction and manual closed reduction, performed under general anesthesia, and the use of interventional MRI to ensure that reduction was achieved and held. The head is turned maximally to the right and left during the manual reduction. A rigid cervical collar was used following reduction. Dynamic CT was not required but prior diagnostic static CT was performed in preparation. No further CT was required. There appears to be no previous studies on interventional MRI in AARF care. Being superior in its diagnostic soft-tissue visualization performance and lacking ionizing radiation, interventional MRI is a potential option for investigating and treating acute AARF in non-syndromic patients with no trauma history.
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Affiliation(s)
- Juuli Hannonen
- Department of Children and Adolescents, Oulu University Hospital, Oulu 90220, Finland
| | - Marja Perhomaa
- Department of Radiology, Pediatric Imaging, Oulu University Hospital, Oulu 90220, Finland
| | - Niina Salokorpi
- Department of Neurosurgery, Pediatric Neurosurgery, Oulu University Hospital, Oulu 90220, Finland.,PEDEGO Research Group and Medical Research Centre Oulu, University of Oulu, Oulu 90014, Finland.,Oulu Craniofacial Center, University of Oulu, Oulu 90220, Finland
| | - Willy Serlo
- Department of Children and Adolescents, Oulu University Hospital, Oulu 90220, Finland.,PEDEGO Research Group and Medical Research Centre Oulu, University of Oulu, Oulu 90014, Finland.,Oulu Craniofacial Center, University of Oulu, Oulu 90220, Finland
| | | | - Jaakko Sinikumpu
- Department of Children and Adolescents, Oulu University Hospital, Oulu 90220, Finland.,PEDEGO Research Group and Medical Research Centre Oulu, University of Oulu, Oulu 90014, Finland.,Oulu Craniofacial Center, University of Oulu, Oulu 90220, Finland
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23
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Anania P, Pavone P, Pacetti M, Truffelli M, Pavanello M, Ravegnani M, Consales A, Cama A, Piatelli G. Grisel Syndrome in Pediatric Age: A Single-Center Italian Experience and Review of the Literature. World Neurosurg 2019; 125:374-382. [PMID: 30797917 DOI: 10.1016/j.wneu.2019.02.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 02/05/2019] [Accepted: 02/06/2019] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Pasquale Anania
- Neurosurgery, Pediatric Hospital Giannina Gaslini, University of Genoa, Genoa, Italy; Neurosurgery, Department of Neurosciences (DINOGMI), Policlinico San Martino, University of Genoa, Genoa, Italy.
| | - Piero Pavone
- Department of Pediatrics, University Hospital B Policlinico-Vittorio Emanuele, Catania, Italy; Department of Pediatrics, AOU Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | - Mattia Pacetti
- Neurosurgery, Pediatric Hospital Giannina Gaslini, University of Genoa, Genoa, Italy
| | - Monica Truffelli
- Neurosurgery, Pediatric Hospital Giannina Gaslini, University of Genoa, Genoa, Italy; Neurosurgery, Department of Neurosciences (DINOGMI), Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Marco Pavanello
- Neurosurgery, Pediatric Hospital Giannina Gaslini, University of Genoa, Genoa, Italy
| | - Marcello Ravegnani
- Neurosurgery, Pediatric Hospital Giannina Gaslini, University of Genoa, Genoa, Italy
| | - Alessandro Consales
- Neurosurgery, Pediatric Hospital Giannina Gaslini, University of Genoa, Genoa, Italy
| | - Armando Cama
- Neurosurgery, Pediatric Hospital Giannina Gaslini, University of Genoa, Genoa, Italy
| | - Gianluca Piatelli
- Neurosurgery, Pediatric Hospital Giannina Gaslini, University of Genoa, Genoa, Italy
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24
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Mkochi VL, Mkandawire N. Grisel syndrome presenting as hemiplegia in a patient with multifocal staphylococcal sepsis. Malawi Med J 2019; 30:127-131. [PMID: 30627341 PMCID: PMC6307069 DOI: 10.4314/mmj.v30i2.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introduction Grisel syndrome is a non-traumatic rotary subluxation of C1 on C2 (atlantoaxial subluxation). It is a rare condition predominantly described in paediatric population with previous history of upper respiratory infections orotolaryngeal procedures. The diagnosis is established by the association of clinical and radiologic findings4,6. We report a case of 15-year old boy with Grisel syndrome accompanying multifocal sepsis (pericarditis, septic polyarthritis, pneumonia and pharangytis ), treated surgically - occipital cervical fusion using struts of iliac crest tri-cortical graft wired to the occiput and C3 and C4. Objective To describe a case of non-traumatic atlantoaxial rotatory subluxation (Grisel syndrome) and to review clinical and radiologic aspects, pathophysiology, and treatment of this rare condition, which if left untreated can lead to catastrophic outcomes. Authors are trying to demonstrate the significance of early intervention for improved outcomes, and that physicians should examine patients with multifocal sepsis thoroughly so as not to miss foci of infection and have high index of suspicion of the syndrome in patients that present with neck swelling, and develop torticollis and neurological deficit. Methods This is a case presentation of a 15-year-old boy who presented with an acute history of neck swelling, shortness of breath, orthopnoea, pericardial effusion, right hip and knee swelling. He later developed torticollis and left sided hemiplegia. On admission, he was septicemic. There was no history of head or neck trauma. Cervical spine radiograph showed increased atlantodental index (ADI) and prevertebral soft tissue swelling. Consent was sought from guardian and patient to use images and case notes for submission for publication. Results The patient was treated with analgesia, drainage of pericardial effusion and intravenous antibiotics. The right knee sepsis was noted on admission and drained on the day pericardial drain was inserted, while the right hip was missed - only to be noted 59 days later with limb length discrepancy. The C1/C2 subluxation was noted 17 days after admission. Reduction was done soon after diagnosis and maintained with a halo-thoracic immobilizer. A week later, he underwent posterior occipital cervical fusion. The hemiplegia resolved fully. Conclusions Multifocal staphylococcal septicemia can present with unusual foci of infection, which may be missed especially if the patient is very sick. Grisel syndrome with an associated left hemiplegia and septic arthritis of the right hip were diagnosed late in this case. Grisel syndrome patients might end up with catastrophic outcomes if left untreated or mis-diagnosed, but if prompt treatment is initiated, full functional recovery is achievable.
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Affiliation(s)
- Vincent L Mkochi
- Assistant lecturer and Postgraduate Trainee in Trauma and Orthopaedics, College of Medicine, University of Malawi
| | - Nyengo Mkandawire
- Consultant Trauma and Orthopaedic Surgeon; Dean of Faculty of Medicine, College of Medicine, University of Malawi
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25
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Iaccarino C, Francesca O, Piero S, Monica R, Armando R, de Bonis P, Ferdinando A, Trapella G, Mongardi L, Cavallo M, Giuseppe C, Franco S. Grisel's Syndrome: Non-traumatic Atlantoaxial Rotatory Subluxation-Report of Five Cases and Review of the Literature. ACTA NEUROCHIRURGICA. SUPPLEMENT 2019; 125:279-288. [PMID: 30610334 DOI: 10.1007/978-3-319-62515-7_40] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
BACKGROUND In children, when unresponsive neck rigidity and distress are observed after ear, nose and throat (ENT) surgical treatment or nasopharyngeal inflammation, Grisel's syndrome should be suspected. This is a rare syndrome involving non-traumatic rotatory subluxation of the atlantoaxial joint. Conservative management with external cervical orthoses and empirical antibiotic, muscle relaxant and analgesic therapy should be the first choice of treatment. Surgical stabilization is indicated when high-grade instability or failure of stable reduction are observed. The instability is graded according to the classification system devised by Fielding and Hawkins. Several recommendations for treatment are available in the literature, but there are no common guidelines. In this paper, the authors discuss the need for prompt diagnosis and treatment considerations. CASE DESCRIPTION Five children with Fielding type I-III rotatory subluxation are reported. Three patients were treated with a cervical collar, and one patient was treated with skull traction and sternal-occipital-mandibular immobilizer (SOMI) brace application. Surgical treatment was necessary for one patient after failure of initial conservative management. The intervals between the onset of torticollis and radiological diagnosis ranged from 12 to 90 days. A relationship between an increased grade of instability and delayed diagnosis was observed. CONCLUSION In children with painful torticollis following ENT procedures or nasopharyngeal inflammation, Grisel's syndrome should always be suspected. Cervical magnetic resonance imaging (MRI) allows prompt and safe diagnosis, and a three-dimensional computed tomography (CT) scan provides better classification of the instability. Surgery, which is indicated in cases of high-grade instability or failure of conservative treatment, may be avoided with prompt diagnosis.
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Affiliation(s)
- Corrado Iaccarino
- Neurosurgery-Neurotraumatology Unit, University Hospital of Parma, Parma, Italy. .,Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
| | - Ormitti Francesca
- Department of Neuroradiology, University Hospital of Parma, Parma, Italy
| | - Spennato Piero
- Neurosurgery Department, Azienda Ospedaliera di Rilievo Nazionale "Santobono-Pausilipon-Annunziata" Children's Hospital, Naples, Italy
| | - Rubini Monica
- Division of Paediatric General and Emergency Care Unit, Children's Hospital of Parma, Parma, Italy
| | - Rapanà Armando
- Neurosurgery Unit, Lorenzo Bonomo Hospital, Andria, Italy
| | - Pasquale de Bonis
- Neurosurgery Department, University Hospital of Ferrara, Ferrara, Italy
| | - Aliberti Ferdinando
- Neurosurgery Department, Azienda Ospedaliera di Rilievo Nazionale "Santobono-Pausilipon-Annunziata" Children's Hospital, Naples, Italy
| | - Giorgio Trapella
- Neurosurgery Department, University Hospital of Ferrara, Ferrara, Italy
| | - Lorenzo Mongardi
- Neurosurgery Department, University Hospital of Ferrara, Ferrara, Italy
| | - Michele Cavallo
- Neurosurgery Department, University Hospital of Ferrara, Ferrara, Italy
| | - Cinalli Giuseppe
- Neurosurgery Department, Azienda Ospedaliera di Rilievo Nazionale "Santobono-Pausilipon-Annunziata" Children's Hospital, Naples, Italy
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26
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Abnormalities of the craniovertebral junction in the paediatric population: a novel biomechanical approach. Clin Radiol 2018; 73:839-854. [DOI: 10.1016/j.crad.2018.05.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 05/15/2018] [Indexed: 12/20/2022]
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Gopinathan NR, Viswanathan VK, Crawford AH. Cervical Spine Evaluation in Pediatric Trauma: A Review and an Update of Current Concepts. Indian J Orthop 2018; 52:489-500. [PMID: 30237606 PMCID: PMC6142799 DOI: 10.4103/ortho.ijortho_607_17] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The clinical presentation and diagnostic workup in pediatric cervical spine injuries (CSI) are different from adults owing to the unique anatomy and relative immaturity. The current article reviews the existing literature regarding the uniqueness of these injuries and discusses the current guidelines of radiological evaluation. A PubMed search was conducted using keywords "paediatric cervical spine injuries" or "paediatric cervical spine trauma." Six hundred and ninety two articles were available in total. Three hundred and forty three articles were considered for the review after eliminating unrelated and duplicate articles. Further screening was performed and 67 articles (original articles and review articles only) related to pediatric CSI were finally included. All articles were reviewed for details regarding epidemiology, injury patterns, anatomic considerations, clinical, and radiological evaluation protocols. CSIs are the most common level (60%-80%) for pediatric Spinal Injuries (SI). Children suffer from atlantoaxial injuries 2.5 times more often than adults. Children's unique anatomical features (large head size and highly flexible spine) predispose them to such a peculiar presentation. The role of National Emergency X-Ray Utilization Study, United State (NEXUS) and Canadian Cervical Spine Rule criteria in excluding pediatric cervical injury is questionable but cannot be ruled out completely. The minimum radiological examination includes 2- or 3-view cervical X-rays (anteroposterior, lateral ± open-mouth odontoid views). Additional radiological evaluations, including computerized tomography (CT) and magnetic resonance imaging (MRI) are obtained in situations of abnormal physical examination, abnormal X-rays, inability to obtain adequate X-rays, or to assess cord/soft-tissue status. The clinical criteria for cervical spine injury clearance can generally be applied to children older than 2 years of age. Nevertheless, adequate caution should be exercised before applying these rules in younger children. Initial radiographic investigation should be always adequate plain radiographs of cervical spine. CT and MRI scans should only be performed in an appropriate group of pediatric patients.
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Affiliation(s)
- Nirmal Raj Gopinathan
- Department of Orthopedic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vibhu Krishnan Viswanathan
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Alvin H Crawford
- Department of Pediatric Orthopedics, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
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Abstract
Painful torticollis in children requires specific attention. Grisel syndrome is diagnosed on suspicion in patients with recent or history of ongoing upper respiratory tract infections and in patients with restriction of movement or deformity following oto-rhino-laryngologic surgery. Pediatricians should be aware of this condition because early diagnosis and intervention are critical for prognosis in Grisel syndrome.
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Affiliation(s)
- Nukhet Aladag Ciftdemir
- Department of Pediatrics, Trakya University Faculty of Medicine,Balkan Yerleskesi, Edirne 22030, Turkey
| | - Tuba Eren
- Department of Pediatrics, Trakya University Faculty of Medicine,Balkan Yerleskesi, Edirne 22030, Turkey
| | - Mert Ciftdemir
- Department of Orthopaedics and Traumatology, Trakya University Faculty of Medicine,Balkan Yerleskesi, Edirne 22030, Turkey
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Das S, Chakraborty S, Das S. Grisel Syndrome in Otolaryngology: A Case Series with Literature Review. Indian J Otolaryngol Head Neck Surg 2016; 71:66-69. [PMID: 31741933 DOI: 10.1007/s12070-016-1030-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 10/17/2016] [Indexed: 12/13/2022] Open
Abstract
Grisel's syndrome is non traumatic atlanto axial subluxation usually associated with inflammatory conditions of head and neck region. Non traumatic atlanto axial joint subluxation is a rare entity for an unsuspecting otolaryngologist. The condition if missed and not treated properly can have serious implications with possible neurological deficit. We attempt to review the existing literature on the disease condition and also to highlight the proper management of the condition. Retrospective analysis of hospital record of last five years and an internet based literature survey on the current concepts and management of the condition. We have come across five cases of Grisel's syndrome over the last five years. The clinicopathological and radiological features are described. Grisel syndrome may remain undiagnosed at initial presentation if not suspected. Delayed diagnosis may result in life long morbidity for the patient and the need for surgical intervention. Many of the early cases can be treated successfully by conservative approach.
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Affiliation(s)
- Soumyajit Das
- 1Department of ENT, Sikkim Manipal Institute of Medical Sciences, 5th Mile, Tadong, Gangtok, 737102 India
| | - Suvamoy Chakraborty
- 1Department of ENT, Sikkim Manipal Institute of Medical Sciences, 5th Mile, Tadong, Gangtok, 737102 India
| | - Subhajit Das
- Department of Radiology, Mazumder Shaw Medical Centre, Bommasandra, Bengaluru, Karnataka 560099 India
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Akuter Schiefhals oder Grisel-Syndrom. MANUELLE MEDIZIN 2016. [DOI: 10.1007/s00337-016-0148-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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