Etiology of child acute stiff neck.

Abstract

The results of MRI study of 10 children with acute stiff-neck who were treated in the Department of Spine Surgery in Saint-Petersburg State Pediatric Medical Academy. To demonstrate the MRI findings in children with acute stiff neck and suggest other explanations to this findings. The etiology of child's acute stiff-neck has been debated in the published data. Most authors supported the basic role of atlantoaxial fixation in this condition. But modern investigations using MRI and CT show another explanations. A total of 10 patients aged 5 to 14 years with typical stiff neck with acute onset were studied by MRI in first 12 hours. In all 10 investigations typical changes that disappeared in a few days were found. There were triangle or oblong high intensity zone near the external edges of backbone discs C2-C3 or C3-C4. The zones were always on the side where the patients felt pain. In our opinion, the main reason of the child's acute stiff-neck is a rapid or gradual strangulation of the vascularized tissue in uncovertebral zones in C2-C3, C3-C4 caused by a head movement or a neck's prolonged incurvationed position during a profound sleep. It causes a "wedge" of hydropic tissues that irritate the back longitudinal ligaments. As the result, a head has antalgic position and, in the most severe cases, is blocked.