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Atlantoaxial instability
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== Risk factors and causes == === Congenital causes === === Rheumatoid arthritis === Chronic inflammation can cause laxity and stretching of the transverse ligament, the formation of a pannus, as well as bone erosion.<ref name="Lacy2019" /> === Grisel’s syndrome === Grisel’s syndrome is AAI that occurs following inflammation of the soft tissue as a consequence of surgery or infection,<ref name="emedicine" /> frequently an upper respiratory infection. It is primarily seen in patients ages 5-12 but can also be seen in adults.<ref name="emedicine">{{Cite web | date = 2019-11-10 | title = Atlantoaxial Instability: Background, Pathophysiology, Etiology | url = https://emedicine.medscape.com/article/1265682-overview#a3}}</ref> It usually presents with torticollis, neck pain, neck tilt, and stiffness.<ref name="Fernandez">{{Cite journal | last = Fernández Cornejo | first = Víctor J. | last2 = Martínez-Lage | first2 = Juan F. | last3 = Piqueras | first3 = Claudio | last4 = Gelabert | first4 = Amparo | last5 = Poza | first5 = Máximo | date = 2003-06-01 | title = Inflammatory atlanto-axial subluxation (Grisel's syndrome) in children: clinical diagnosis and management | url = https://doi.org/10.1007/s00381-003-0749-6 | journal = Child's Nervous System|language=en | volume = 19 | issue = 5 | pages = 342–347|doi=10.1007/s00381-003-0749-6|issn=1433-0350}}</ref> It can often be treated with conservative therapies such as physical therapy, traction, immobilization, anti-inflammatories and treatment of any underlying infection.<ref name="Fernandez" /> A handful of cases of concomitant non-traumatic CCI and AAI following upper respiratory infections have also been documented.<ref name="Washington1998">{{Cite journal | title = Nontraumatic Atlanto-occipital and Atlantoaxial Rotatory Subluxation: Case Report | url = https://academic.oup.com/neurosurgery/article/43/1/162/2856810 | journal = Neurosurgery | date = 1998-07-01|issn=0148-396X | pages = 162–164 | volume = 43 | issue = 1|doi=10.1097/00006123-199807000-00110|language=en | first = Shehan | last = Hettiaratchy | first2 = Chou | last2 = Ning | first3 = Ian | last3 = Sabin}}</ref><ref>{{Cite journal | title = Non-Traumatic Atlanto-Occipital and Atlanto-Axial Dislocation: A Case Report | url = https://journals.lww.com/jbjsjournal/Citation/1959/41020/Non_Traumatic_Atlanto_Occipital_and_Atlanto_Axial.15.aspx | journal = JBJS | date = Mar 1959|issn=0021-9355 | pages = 341–344 | volume = 41 | issue = 2|language=en-US| first = Eleby R. | last = Washington | last2 = | first2 = | doi = | pmc = | pmid = | quote = |access-date=|via=}}</ref>
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