Education And Debate

Lesson of the Week: Don't twist my child's head off: iatrogenic cervical dislocation

BMJ 1995; 311 doi: (Published 04 November 1995) Cite this as: BMJ 1995;311:1212
  1. A T H Casey, spinal research fellowa,
  2. M O'Brien, international spinal research fellowa,
  3. V Kumar, neurosurgical registrarb,
  4. R D Hayward, consultant neurosurgeonb,
  5. H A Crockard, consultant neurosurgeona
  1. aThe National Hospital for Neurology and Neurosurgery, London WC1N 3BG
  2. bThe Hospital for Sick Children, London WC1N 3JH
  1. Correspondence to: Mr Crockard.
  • Accepted 24 March 1995

Excessive rotation of two children's necks while they were undergoing cervical lymph node biopsy probably resulted in their dislocation; delayed diagnosis necessitated complex spinal surgery to correct the deformity. “Wry” neck, a synonym for atlantoaxial rotary subluxation, is a relatively common condition in young children often associated with tonsillitis. It usually resolves spontaneously,1 because the joint surfaces remain in contact. A rotation injury is another possible cause, often following an apparently minor trauma such as heading a football. Iatrogenic torticollis is rarely reported. A complete dislocation of the atlantoaxial joint will not resolve spontaneously and may have important long term effects on the child's facial development. We have treated two otherwise normal children whose necks were dislocated under general anaesthesia while they were undergoing cervical lymph node biopsy. The injury was not appreciated at once and definitive treatment was inevitably delayed.

  • “Wry neck” in children may be due to atlantoaxial rotatory subluxation and should be promptly evaluated by detailed cervical spine radiography

Case reports CASE 1

A 10 year old girl underwent lymph node biopsy from the posterior triangle of her neck. After surgery she awoke with a torticollis, a painful neck, and occipital dysaesthesiae. These symptoms ultimately subsided on conservative treatment but the torticollis persisted. Radiography at that stage showed …

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