Pediatric emergency medicine trisk 0960 0960
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Subluxation of the Cervical Spine. Traumatic subluxations of the cervical spine
are more common than fractures in children and are more likely to present more
than 24 hours after injury. Subluxation may result from minor trauma (e.g., falls
from low heights) but typically occurs after more severe trauma (see Chapter 112
Neck Trauma ). The most common subluxation is rotary (or “rotatory”)
atlantoaxial subluxation. Clinically, rotary subluxation typically causes neck pain
and torticollis without focal neurologic symptoms because the transverse
ligament of the atlas remains intact and the spinal cord is not compromised.
Sternocleidomastoid (SCM) spasm and neck tenderness are localized to the same
side as the head rotation as the SCM attempts to “reduce” the deformity. This is in
contrast to other causes of torticollis, in which the spastic, tender SCM muscle is
opposite to the direction of head rotation. In addition, in rotary subluxation, there
is palpable deviation of the spinous process of C2 in the same direction as the
head rotation. In contrast, during normal neck rotation beyond 20 degrees, the
spinous process of C2 deviates to the contralateral side.
