Three-dimensional spiral CT scanning in children with acute torticollis

Three-dimensional spiral CT scanning is now becoming a common investigation in children who have a history of acute torticollis. In the last year, 21 consecutive children who came to our unit with a history of acute torticollis were assessed using standard plain radiographs and a 3-dimensional spiral CT scan. Ten patients had a history of recent trauma. Spiral CT scanning revealed that 13 children had atlanto-axial rotatory subluxation (AARS). Plain radiographs had only a sensitivity of 33% and specificity of 71% in detecting AARS. Sixteen children were treated using a Halter traction. Four failed to resolve clinically and were put on a halo traction after 3-dimensional CT scanning again confirmed residual AARS. Two children remained symptomatic after halo traction, with persisting rotatory and anterior subluxation on repeat spiral CT. They both underwent a posterior in-situ fusion, with no attempt at open reduction. Plain radiography is limited in investigating acute torticollis in children. Spiral 3-dimensional CT reconstruction has an important role to play in both the investigation and management of children who present with acute torticollis.