Grisel syndrome is a type of subluxation that occurs in the spine of the neck. A subluxation is when a joint is incompletely dislocated. In Grisel’s syndrome, the so-called atlantoaxial joint is affected by the dislocation. In most cases, the cause of the disease is a protective posture that often results from inflammatory processes in the neck or throat.
What is Grisel syndrome?
Grisel syndrome is referred to by some physicians by the synonymous disease name Watson-Jones disease. The condition was first described by a Frenchman, Doctor Grisel. In the course of the disease, the affected patients adopt a protective posture of the spine in the region of the neck. In the majority of cases, the triggering factor of Grisel’s syndrome is found in an inflammation of the throat, nose or neck. The characteristic symptom of Grisel syndrome is subluxation of the spine of the neck. In particular, the so-called atlantoaxial joint is affected by the incomplete dislocation that occurs during the disease.
Causes
The causes of Grisel syndrome are comparatively well studied and known. In most cases, the condition develops as a result of trauma. Various factors may be involved, such as inflammation of soft tissues in the nose, throat, and pharynx or inflammation of the tonsils. In addition, diseases of a rheumatic nature can be considered as a potential cause of Grisel’s syndrome. In some patients, the disease also develops after surgical interventions in the corresponding area, for example, after surgical removal of the tonsils (medical term tonsillectomy). In the majority of cases, the aforementioned inflammations are responsible for the development of Grisel’s syndrome. In contrast, rheumatism is much less common as a cause of the disease.
Symptoms, complaints, and signs
If a person suffers from Grisel syndrome, a number of complaints and symptoms are typical and occur in clusters. First and foremost, this includes a relieving posture of the spine in the area of the neck. The cause of this poor posture is usually pain radiating from the area of the neck. As a result, there is an incomplete dislocation of the atlantoaxial joint, which is located in the spine of the corresponding area. As the atlas is displaced to some extent and shifted laterally, intense pain occurs in the neck area. In addition, patients suffering from Grisel syndrome hold their head at such an angle that the malposition is easily apparent.
Diagnosis and course
A diagnosis of Grisel syndrome is made on the basis of the clinical symptoms and complaints present, which are usually checked by various methods of examination technique. If several examination techniques show the same results, Grisel syndrome can be diagnosed with relative certainty. If persons suffer from the decisive symptoms of the disease, it is not recommended to wait long for improvement. Instead, an appropriate physician should be consulted immediately, and the symptoms should be presented to him or her. Sometimes the family doctor will refer the patient to a specialist. The first step in any examination is to take the patient’s medical history. Here, the affected patient describes his symptoms as well as his lifestyle and possible activities that may have contributed to the development of the disease. It is particularly important for the doctor to find out about any recent inflammations of the throat or pharynx. In some cases, a tentative diagnosis can already be made in this way. Once the patient interview is over, the doctor uses various examination techniques. As a rule, an examination using X-ray technology is obligatory. Here, the physician focuses on the area of the cervical spine. The imaging provides significant indications of the presence of Grisel’s syndrome. Certainty is provided by an MRI examination, which is additionally performed in numerous cases. Before Grisel’s syndrome is finally diagnosed, a differential diagnosis must be performed. The physician checks whether the symptoms may occur as a result of other diseases. For example, ankylosing spondylitis, Klippel-Feil syndrome, tension in the muscles around the neck, and congenital torticollis are considered.In addition, patients are checked for torticollis, in which they have hearing loss in one ear and the vestibular organ is damaged.
Complications
Grisel’s syndrome results in pain that is too severe for the patient. Because of this pain, most affected individuals adopt a protective posture, which has a very negative effect on the back and spine. Furthermore, the pain can also spread to other regions, so that the neck, for example, can also be affected. The head is held very crooked in this case, as holding it straight would lead to severe pain. For this reason, a relatively simple and quick diagnosis is possible, so that treatment can also be initiated at an early stage. Without treatment, the pain and discomfort of Grisel syndrome will persist and no spontaneous healing or improvement will occur. It is not uncommon for the severe and persistent pain to lead to restricted mobility and thus to depression and further psychological discomfort. The treatment of Grisel’s syndrome is always causal and depends on the underlying disease. As a rule, medication is used and no further complaints or complications arise. There is a positive course of the disease in most cases.
When should one go to the doctor?
Because Grisel syndrome is associated with very specific symptoms and complaints in most cases, it can be detected and treated early. Treatment by a doctor is necessary in any case, because this syndrome does not heal itself and in most cases the symptoms worsen. A doctor should be consulted if there is severe pain in the neck or spine. The pain may also radiate to neighboring regions of the body. Furthermore, those affected often adopt a protective posture in order to reduce the pain. This incorrect posture is usually obvious, so that other people can also point out Grisel’s syndrome to the affected person. Therefore, if the pain persists over a long period of time and is not associated with particular activities, an orthopedist should be consulted. In cases of very severe pain or emergencies, the hospital may also be visited. Usually, Grisel syndrome can be treated well.
Treatment and therapy
Various treatment approaches can be considered for the therapy of Grisel syndrome. However, in principle, the measures depend on the underlying cause, which differs to some extent in individual cases. Thus, the first goal of therapy for Grisel syndrome is to treat the underlying disease in question. In some cases, the affected patients receive so-called analgesics. In the majority of individuals, conservative methods of therapy show relatively good success. If abscesses form, they are usually removed during surgical procedures. Timely diagnosis of Grisel’s syndrome allows a rapid start of treatment, so that the healing process of the disease or the underlying causes is accelerated. In this way, the quality of life of those suffering from Grisel syndrome is significantly increased.
Outlook and prognosis
Grisel syndrome can be well treated. If the movement restrictions and pain are assigned to a cause at an early stage, individualized therapy can be initiated that will cause the symptoms to subside quickly. The prospect of a rapid recovery is good if the sufferer has no previous illnesses and responds well to drug treatment. Any tension or muscle pain can be relieved just as effectively by physiotherapy. If Grisel’s syndrome is detected and treated in the early stages, symptoms resolve completely within a few days to weeks. Late effects or serious complications do not usually occur. The prognosis is worse if no treatment or inadequate treatment is given. In this case, the symptoms described increase in intensity and considerably restrict the person affected. Quality of life and well-being decrease in the course of the disease and mental illness may develop. In individual cases, abscesses can form that have to be surgically removed. If the growths are located on the spine, paralysis is also conceivable. However, the prognosis is generally positive.Grisel syndrome usually progresses very slowly and can be clearly diagnosed and subsequently effective based on symptoms.
Prevention
Prevention of Grisel syndrome is possible by paying attention to and avoiding causative factors. Prompt therapy is required for inflammation of the neck to avoid promoting the development of Grisel syndrome. The same applies to rheumatic diseases.
Follow-up
In Grisel syndrome, follow-up usually proves to be relatively difficult because the syndrome cannot be fully treated. In the first instance, therefore, the patient must rely on medical evaluation to prevent further complications and relieve symptoms. It cannot be universally predicted whether a complete cure is possible. The therapy depends very much on the underlying disease. The affected person is usually dependent on taking medication. Regular intake is important, and interactions with other drugs must also be taken into account. In cases of doubt, a doctor should always be consulted. Often, the symptoms of Grisel’s syndrome can be limited relatively well with the help of medication. In some cases, however, abscesses form, so that surgical intervention is necessary. After such an operation, the affected person should always rest and take care of the body. Strenuous activities or sporting activities should be avoided in order to speed up the healing process. In general, a healthy lifestyle with a balanced diet also has a very good effect on the further course of the disease. The life expectancy of the affected person is usually not reduced by Grisel syndrome.
What you can do yourself
The measures people with Grisel syndrome can take themselves depend on the underlying cause and the type of medical treatment they receive. Basically, the most important action is to follow the doctor’s instructions regarding prescribed medications and any physical therapy exercises. If abscesses form, care must be taken to maintain adequate hygiene to prevent inflammation. If the pain is severe, the physician will usually prescribe an analgesic. Occasionally, a milder preparation from natural medicine can also be used to reduce neck pain and inflammation. However, this should first be discussed with the doctor. If Grisel’s syndrome persists despite these measures, a visit to the doctor is indicated. In most cases, surgery must then be performed. After a surgical procedure, bed rest and sparing apply. The neck area in particular must be spared, as there is a certain risk of the wound opening up again. For this reason, it is recommended to support the neck with the help of a pillow or neck support. In addition, a physician must monitor the healing process and ensure that the medications used do not cause any side effects or interactions.
