Intraoperative Ultrasonography for the Surgical Treatment of Grisel Syndrome of the Adult: Management of A Rare Condition

Study design: This is a narrative review and case report.

Objective: To review the literature concerning Grisel syndrome physiopathology, diagnosis, and surgical reports, highlighting the decision-making for treatment and its timing. We describe the role of intraoperative US in the management of 2 cases of GS of the adult.

Summary of background data: GS is a rare nontraumatic post inflammatory C1-C2 rotatory instability usually affecting children; adult cases are even rarer, and the role of surgical treatment is not well defined.

Case discussion: Case 1: A 72-year-old man with upper cervical pain and no neurological deficit; radiologic examination revealed C1-C2 spondylitis and epidural abscess. After antibiotic therapy, the patient developed cervical instability. Hence, surgical decompression and C1-C2 stabilization were performed. Case 2: An 82-year-old woman with progressive right hemiparesis. CT and MRI showed C1-C2 spondylitis with retro-odontoid epidural abscess. Atlanto-axial rotatory instability was evident so surgery was achieved. In both cases, intraoperative US was useful for localizing retro-odontoid abscess and allowing safe puncture of the collection, leading to its remarkable radiologic reduction.

Conclusion: GS in adults remains a challenge: Patients should be closely monitored concerning neurological and inflammatory status. We describe the successful use of intraoperative US for draining retro-odontoid abscess for the first time, with satisfactory postoperative outcome without need of circumferential approach.