Atlantoaxial rotatory displacement in children

Table 3 Clinical findings

Pt #	Pang	Age	Gen	History	Delay to initial presentation	Prior treatment	1° Rx.	Dur (d)	Results	2° Rx.	Dur (d)	Results	3° Rx.	Dur (wk)	Outcome	Immobilization	FU (wk)	Final results
1	1, 1	8	F	Fell backwards while walking	3 wk initial, referred after 6 mo	3, 5	5	14	3	6		1				PH × 6 wk, SC × 1 wk	108	1
2	1, 3	8	F	Shaking water from ear	4 wk	3, PT	4	7	3	4	10	3	5	3	1	PH × 3 mo	150	1
3	2, 4	7	M	Goldenhar syndrome, ear reconstruction	7 d	None	4	8	1	-	-	-	-	-	-	PH × 4 wk	NR	1
4	2	6	F	Crouzon syndrome, midfacial advancement	None	None	4	10	1	-	-	-	-	-	-	PH × 4 wk	2	1
5	2	10	F	Pharyngitis	7 d	None	4	14	1	-	-	-	-	-	-	PH × 2 mo	6	1
6	2	7	M	Awakened with stiff neck	10 d	None	4	3	2	4	4	2	-	-	-	None	2	1
7	2, 4	13	F	ADN	7 d	None	4	7	1	-	-	-	-	-	-	HC × 6 wk	2	1
8	2, 5	7	M	Tonsillectomy/ADN, Klippel-Feil	5 d	None	4	7	1	-	-	-	-	-	-	SC	2	1
9	2	8	F	Tonsillectomy/ADN	4 d	None	1	10	2		NR	2	NR	NR	NR	SC	1.5	1
10	5, 2	5	M	Golderhar Syndrome, Hemifacial microsomia. 2 episodes S/P mandibular reconstruction and zygoma and mandible reconstruction	4 d	None	4, 4	4, 5	1	-	-	-	-	-	-	PH × 4 wk, HC × 3 wk		1
11	5, 5, 2	9	M	Neck pain	Unknown	None	4	5	3	-	-	-	-	-	-	PH × 3 wk	18	3
12	4	6	M	Unknown	Unknown	None	1	-	-	-	-	-	-	-	-	-	-	No Ortho
13	4	5	M	Unknown	4-5 mo	None	Outpatient consult	-	-	-	-	-	-	-	-	None	NA	1
14	4	6	F	Scarlet fever	6 wk	6 wk of oral antibiotics	Outpatient consult	-	-	-	-	-	-	-	-	-	NA	1
15	4	6	M	Unknown	ER	None	1	-	-	-	-	-	-	-	-	-	-	No Ortho
16	4	8	M	Unknown	ER	None	3	-	-	-	-	-	-	-	-	PH × 8 wk	-	No Ortho
17	4	9	M	All terrain vehicle injury, occipital condyle fracture	None	None		1	-	-	-	-	-	-	-	-	20	1
18	4	6	F	Cervical lymphadenitis	None	2	4	-	-	-	-	-	-	-	-	HC × 1 wk	1	1
19	4	5	F	Congenital muscular torticolis	1 mo	Torticolis sx at 1.5 yr of age	Bipolar Release	-	1	-	-	-	-	-	-	-	-	-
20	4, 4	12	F	Retropharyngeal abscess	3-4 d	None	4	10	1	-	-	-	-	-	-	SC × 2 wk	3	1
21	4	6	M	Throwing ball	2 wk	4	4	14	2	-	7	2			2	Persistent	1	1
22	4	9	F	Unknown	None	None	PT	-03/ 17/ 003	-		-	-	PT			Recurrence	18	-
23	4	7	F	Choanal Atresia repair, ADN	2 d	2	1	2	2	4	-	-	-	-	-	CTO × 6 wk	9	1
24	4	8		Wrestling	None	None	3		-	-	-	-	-	-	-	HC	-	No FU
25	4	10	M	ADN	None	None	3	.	-	-	-	-	-	-	-	-	-
26	4, 4	8	F	Minor trauma doing handstand	None	None	4	5	1	-	-	-	-	-	-	-	18	1
27	4, 4	4	F	None	NA	None	3 PT	2	1	-	-	-	-	-	-	SC × 2 wk	2	1
28	5	12	F	Turning head during sleep	1 d	None	3	-	-	-	-	-	-	-	-	-	-	No FU
29	5	14	F	Down syndrome	None	None	4	10	2	-	-	-	-	-	-	PH × 6 wk/SC, PT	8	1
30	5	6	F	ADN	3-4 d	None	4	2	1	-	-	-	-	-	-	SC × 3 wk, PT	8	1
31	5	5	F	Pharyngitis	3-4 d	None	3	-	1	-	-	-	-	-	-	SC × 2 wk	8	1
32	5	7	M	Lymphadenitis	4 wk	PT	4	7	1	-	-	-	-	-	-	HC × 6 wk	20	1
33	5	6		ADN	None	None	4	3	1	-	-	-	-	-	-	HC × 6 wk, PT	6	1
34	5	6	F	Serving tennis	4 wk	None	3	10	1	-	-	-	-	-	-	-	1.5	No FU
35	5	9	M	URI	2 d	None	4	7	3	4	3	1	-	-	-	PH × 8 wk	10	1

All patients had neck pain, torticollis, and a normal neurologic examination. Clinical information includes age, gender, historical features, delay to presentation, previous treatment, treatment course and duration, immobilization, results and follow-up. Delay: Time from symptoms to evaluation in days; HC: Hard cervical collar; SC: Soft cervical collar; CTO: Cervicothoracic orthosis; PT: Physical therapy; AND: Adenoidectomy; URI: Upper respiratory infection; Treatment: 1: Analgesic with or without an antibiotic; 2: Analgesic, muscle relaxant, with or without an antibiotic; 3: Soft or hard collar; analgesic, muscle relaxant with or without an antibiotic; 4: Admission, skin traction, analgesics, muscle relaxant; 5: Skeletal traction; 6: C1-C2 arthrodesis; Results of treatment: 1: Resolved; 2: Persistent; 3: Relapse; Final results: 1: Asymptomatic, normal activities; 2: Persistent tilt, no pain, no other symptoms; 3: Persistent torticollis, pain and/or other symptoms.