they occur most commonly in the thoracic and lumbar areas Localized pain, fever, and elevation of inflammatory markers including erythrocyte sedimentation rate (ESR) and C-reactive protein generally accompany these infections Cervical vertebral osteomyelitis may lead to neck stiffness Vertebral osteomyelitis is usually bacterial in origin (most commonly caused by S aureus ) but may be caused by mycobacteria as well If the cervical spine is involved, radiographs of this area may reveal destruction of the vertebral body, local soft tissue swelling, or narrowing of the disc space MRI is the imaging modality of choice and may reveal abnormalities of the spine before bony destruction is visible on plain radiography Although uncommon, spinal epidural abscesses are associated with significant morbidity and mortality When these abscesses occur in the cervical region, severe neurologic deficits may occur, and emergent neurosurgical consultation is essential Discitis is uncommon in children; however, cases of cervical discitis have been reported This disease is generally seen in children younger than years of age The most commonly identified microbiologic organism is S aureus, although bacterial cultures are commonly negative and the cause has been debated When evaluating for this condition, MRI is indicated Generally Non–Life-Threatening Causes Torticollis due to Minor Irritation, Malposition, and Muscle Spasm Most well-appearing children with sudden onset of torticollis without a history of trauma, fever, or neurologic abnormalities not have serious underlying pathology as a cause of their symptoms Commonly, the patient awakens with mild neck pain and stiffness On evaluation, there is no history of trauma, fever, preceding illness, pharyngotonsillitis, or any additional physical examination abnormality The examination reveals a well-appearing child with torticollis, whose limitation of motion is primarily when he or she attempts correction of the malposition Such muscular torticollis may be due to SCM spasm from awkward sleeping position or other mild irritation In cases with this type of benign presentation, nothing more than clinical assessment by history and examination, analgesic/anti-inflammatory medication, consideration of soft cervical collar, and close follow-up may be necessary Grisel Syndrome Atlantoaxial subluxation uncommonly may occur as a result of inflammatory processes in the head and neck region (e.g., rheumatoid arthritis, systemic lupus erythematosus, tonsillitis, pharyngitis, otitis media,