Objective and importance: We report our recent experience with two cases of C3-C4 ligamentous instability that developed after the onset of an upper airway infection. To our knowledge, this is the first report in the literature of a variant of Grisel's syndrome occurring at the midcervical levels. The diagnosis and management of this entity are presented.
Clinical presentation: Two infants with respiratory distress were evaluated at the Children's Hospital of Buffalo. During evaluation, cervical spine x-rays showed midcervical translational instability. Neither patient had a neurological deficit nor a history of trauma or bone disease.
Intervention: One of the patients was immmobilized with an external orthosis.
Conclusion: Each patient remained neurologically intact, and the cervical spine returned to normal alignment after several months. We discuss a possible mechanism for this unusual association and recommend external immobilization.