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Isolated Alar Ligament Disruption in Children and Adolescents as a Cause of Persistent Torticollis and Neck Pain After InjuryA Report of Three Cases
Michelle S. Caird, MD1; Robert N. Hensinger, MD1; Kelly L. Vander Have, MD1; Martin K. Gelbke, MD2; Frances A. Farley, MD1
1 Pediatric Orthopaedics Service, Department of Orthopaedic Surgery, The University of Michigan, 1500 East Medical Center Drive, TC 2912, Ann Arbor, MI 48109. E-mail address for M.S. Caird: sugiyama@med.umich.edu
2 230 Michigan Avenue N.E., Grand Rapids, MI 49503
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
Investigation performed at the Department of Orthopaedic Surgery, The University of Michigan, Ann Arbor, Michigan

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2009 Nov 01;91(11):2713-2718. doi: 10.2106/JBJS.H.01405
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The alar ligaments are small paired spinal ligaments that attach from the occiput to the proximal portion of the odontoid process of the second cervical vertebra (C2). Injury to the upper cervical spine in children is infrequent, and isolated injury of the alar ligaments is even more uncommon, with only a report of two cases, in German, appearing in the literature1. Here we describe isolated alar ligament disruptions in three children. This injury caused persistent torticollis and neck pain in which neither fracture nor anterior or posterior listhesis was detected on radiographic studies. The injury did not lead to instability in the upper cervical spine in any of the patients.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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