pediatrics
Congenital Neck and Back Abnormalities
Congenital torticollis
The head becomes tilted at or soon after birth. Themost common causeis Neck injury during delivery Torticollis that develops within the first few days or weeks of life may result from an injury that causes a hematoma, with subsequent fibrosis and contracture of the sternocleidomastoid (SCM) muscle. A nontender mass may be noted in the SCM, usually in the midsegment. Torticollis is a frequent cause of plagiocephaly (flattening of one side of the head) and asymmetric facies (see Cervical Dystonia ). Other causesof congenital torticollis include spinal abnormalities, such as Klippel-Feil syndrome (fusion of the cervical vertebrae, short neck, and low hairline, often with urinary tract abnormalities) or atlanto-occipital fusion. Specific gene defects (eg, mutations inGDF6,GDF3, andMEOX1) may be involved. Central nervous system tumors, bulbar palsies, and ocular dysfunction are common neurologic causes but are rarely present at birth. Fractures, dislocations, or subluxations of the cervical spine (especially C1 and C2) or odontoid abnormalities are rare but serious causes; permanent neurologic damage may result from spinal cord injury. Cervical imaging should be done to exclude bony causes, which may require stabilization. When torticollis is due to birth trauma, frequent passive SCM stretching (rotating the head and stretching the neck laterally to the opposite side) is indicated. Injections of botulinum toxin into the SCM may help in refractory cases. 