Current management of pediatric XXXX .

@entity1 @entity7551 @entity4048 @entity3799 @entity9807 @entity2346 @entity130
STUDY DESIGN: A retrospective clinical review of 20 @entity1 seen during a 7-year period who had @entity9807 . OBJECTIVE: To define the effectiveness of imaging and treatment measures and to identify risk factors for recurrence, the series was reviewed to analyze cause, management, and outcome. SUMMARY OF BACKGROUND DATA: Rotatory subluxation of the atlantoaxial complex remains a poorly understood entity. Despite many reports in the literature, there is no consensus about which imaging studies should be used for diagnosis and which @entity1 benefit from collar immobilization, traction, or surgical fusion. METHODS: Between August 1990 and April 1997, 20 @entity1 with @entity9807 were treated. Fourteen @entity1 (70%) were @entity1 and six (30%) were @entity1 (mean age, 6.4 years). All @entity1 had torticollis and @entity4048 with @entity3799 for a mean of 11.2 days before diagnosis. Seven @entity1 (35%) had a history of @entity7551 or @entity2346 media, four (20%) had recently undergone head or neck surgery, and four (20%) had sustained a @entity130 ; in five @entity1 (25%), no clear cause was determined. All @entity1 were neurologically intact and underwent plain cervical radiographs and dynamic cervical computed tomography to document @entity9807 . @entity1 were then treated with a rigid cervical collar and anti-inflammatory agents (n = 5) or with cervical traction followed by immobilization (n = 15). RESULTS: In four of the five @entity1 in collars, reduction occurred spontaneously, whereas the fifth required cervical traction and eventual fusion for recurrence. In the 16 @entity1 treated with traction (median, 1.8 kg), the normal atlantoaxial alignment was restored in 15 @entity1 (94%) within a mean of 4 days. Of the 20 @entity1 treated overall, conservative management failed in 6 (30%), and they required posterior fusion because of recurrence of the @entity9807 or unsuccessful reduction. The major factor predicting the failure of conservative management was the duration of subluxation before initial reduction. @entity1 with long-standing subluxation were more likely to experience recurrence and require surgery. There were no complications noted. At follow-up, all @entity1 who were treated conservatively remained neurologically intact with a normal atlantoaxial relation. All @entity1 who underwent surgery remained neurologically intact and had radiographic documentation of fusion. CONCLUSION: Optimal management of @entity9807 entails early diagnosis with plain cervical radiographs and dynamic computed tomography. Closed reduction with cervical traction followed by rigid immobilization accomplished reduction in 15 of 16 @entity1 (94%) and was curative in 10 of 16 @entity1 (63%). Although reduction was achieved more rapidly and effectively with traction than with a collar, there may be a role for simple immobilization without reduction in @entity1 with a short duration of symptoms. There does not appear to be a correlation between cause of @entity9807 , age, or sex and the likelihood of recurrence.
