This is a rare complication that follows an inflammatory process in the head and neck region. It involves disruption of the ligamentous support of the atlanto-axial joint, probably due to oedema of the atlanto-axial ligaments and aconsequent increase in laxity. The clinical findings include neck tenderness and torticollis opposite to the side of subluxation. The spinous process of the axis opposite to the side of the subluxation may be palpable (Sudek’s sign). The presence of neurological sequelae depends upon the severity of the subluxation.The investigation of choice is either a high resolution CT scan to demonstrate bony subluxation or an MRI scan to demonstrate inflammation of the atlanto-axialligaments. Neurosurgical advice must be sought as soon as the diagnosis is made as it can have devastating consequences if not detected and treated early.
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