Hypermobility of the cervical spine in children: A pitfall in the diagnosis of cervical dislocation

Abstract

Subluxation of the cervical vertebrae not associated with fracture occurs frequently in children. Three types are recognized, namely, spontaneous atlantoaxial dislocation, unilateral suboccipital dislocation and rotary unilateral subluxation below the second cervical vertebra. Pain, torticollis, muscular spasm and limitation of motion almost always accompany these types of subluxation. Hypermobility of the second and third cervical vertebra, or apparent subluxation, also is encountered frequently in children and is a normal variation. In a roentgenographic study, fifteen of 100 normal children had a “step-off” between the second and third or the third and fourth cervical vertebrae of 3.5 or 4 mm. Unless the roentgenographic interpretation is confirmed by the physical signs of genuine subluxation, overtreatment by means of prolonged traction or immobilization in a cast may be carried out under the misconception that serious injury exists.