Midcervical postinfectious ligamentous instability: A variant of Grisel's syndrome

Objective and Importance: We report our recent experience with two cases of C3-C4 ligamentous instability that developed after the onset of an upper a irway infection. To our knowledge, this is the first report in the literatu re of a variant of Grisel's syndrome occurring at the midcervical levels. T he diagnosis and management of this entity are presented. Clinical Presenta tion: Two infants with respiratory distress were evaluated at the Children' s Hospital of Buffalo, During evaluation, cervical spine x-rays showed midc ervical translational instability, Neither patient had a neurological defic it nor a history of trauma or bone disease. Intervention: One of the patien ts was immmobilized with an external orthosis. Conclusion: Each patient rem ained neurologically intact, and the cervical spine returned to normal alig nment after several months. We discuss a possible mechanism for this unusua l association and recommend external immobilization.