Universität zu Köln

Heck, Vincent J. ORCID: 0000-0002-2541-6032, Eysel, Peer ORCID: 0009-0004-6057-6092, Prasse, Tobias ORCID: 0000-0002-3767-5461, Scheyerer, Max J. and Eysel-Gosepath, Katrin (2026). The Grisel Syndrome: early interdisciplinary treatment needed to prevent severe upper cervical deformity - Experience from a high-volume spine center and systematic review of existing literature. International Journal of Pediatric Otorhinolaryngology, 200. pp. 1-8. Elsevier. ISSN 01655876

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Abstract

[Artikel-Nr.: 112656] Purpose: Grisel Syndrome (GS) describes a rare, non-traumatic atlantoaxial rotatory subluxation in children typically associated with upper respiratory tract infection, or otorhinolaryngological surgery. The aim of this study was to systematically review the literature regarding interdisciplinary treatment approaches, consequences of delayed or misdiagnosed GS, and upper cervical deformities resulting from misdiagnosed GS. Additionally, we share our institutional experience with this pathology. Methods: We queried our institutional database for patients suffering from GS which were treated in our department between 2001 and 2024. A systematic literature search was conducted using Medline and the Cochrane Library, following PRISMA guidelines. Results: Our database revealed three patients with GS. One patient with misdiagnosed of GS presented with rigid occipital rotation, ultimately progressing to occipito-atlantoaxial rotatory dislocation (OAARD). Two patients were early diagnosed and successfully treated with halo vest immobilization. The systematic literature review identified 13 cases of OAARD across 12 reports. Etiologies included upper respiratory infections, otorhinolar- yngological surgery, juvenile idiopathic arthritis, and minor trauma. The average time to diagnosis of OAARD was 5.9 months (0.5–18 months). The treatment involved occipito-atlantal fusion (43 %), atlantoaxial fusion with halo vest (29 %), or traction followed by halo vest (21 %). Conclusion: GS and OAARD are underrecognized and often diagnosed late, causing irreversible deformity and permanent loss of upper cervical spine mobility. Painful torticollis following upper respiratory tract infection, otorhinolaryngological surgery, or minor trauma should be treated as GS until proven otherwise. Early recog- nition and interdisciplinary treatment are crucial to prevent progression and avoid invasive surgical interventions.

Item Type:	Article
Creators:	Creators Email ORCID ORCID Put Code Heck, Vincent J. UNSPECIFIED https://orcid.org/0000-0002-2541-6032 UNSPECIFIED Eysel, Peer UNSPECIFIED https://orcid.org/0009-0004-6057-6092 UNSPECIFIED Prasse, Tobias UNSPECIFIED https://orcid.org/0000-0002-3767-5461 UNSPECIFIED Scheyerer, Max J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Eysel-Gosepath, Katrin UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-812767
Identification Number:	10.1016/j.ijporl.2025.112656
Journal or Publication Title:	International Journal of Pediatric Otorhinolaryngology
Volume:	200
Page Range:	pp. 1-8
Number of Pages:	8
Date:	January 2026
Publisher:	Elsevier
ISSN:	01655876
Language:	English
Faculty:	Faculty of Medicine
Divisions:	Faculty of Medicine > Orthopädie > Klinik und Poliklinik für Orthopädie und Unfallchirurgie
Subjects:	Medical sciences Medicine
Uncontrolled Keywords:	Keywords Language Grisel syndrome ; Atlantoaxial rotatory subluxation ; Occipital counter rotation ; OAARD ; Upper respiratory tract infection ; Otorhinolaryngological surgery ; Interdisciplinary treatment English
['eprint_fieldname_oa_funders' not defined]:	Publikationsfonds UzK
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/81276