Subluxation of the Cervical Spine Traumatic subluxations of the cervical spine are more common than fractures in children and are more likely to present more than 24 hours after injury Subluxation may result from minor trauma (e.g., falls from low heights) but typically occurs after more severe trauma (see Chapter 112 Neck Trauma ) The most common subluxation is rotary (or “rotatory”) atlantoaxial subluxation Clinically, rotary subluxation typically causes neck pain and torticollis without focal neurologic symptoms because the transverse ligament of the atlas remains intact and the spinal cord is not compromised Sternocleidomastoid (SCM) spasm and neck tenderness are localized to the same side as the head rotation as the SCM attempts to “reduce” the deformity This is in contrast to other causes of torticollis, in which the spastic, tender SCM muscle is opposite to the direction of head rotation In addition, in rotary subluxation, there is palpable deviation of the spinous process of C2 in the same direction as the head rotation In contrast, during normal neck rotation beyond 20 degrees, the spinous process of C2 deviates to the contralateral side