retropharyngeal abscess) or after otolaryngologic procedures (e.g., tonsillectomy, adenoidectomy) When due to such infectious or inflammatory conditions, the subluxation is called Grisel syndrome and is believed to occur as a result of ligamentous laxity The subluxation may or may not be associated with displacement of the atlas, depending on the degree of involvement of the transverse ligament of the atlas Most children with Grisel syndrome have torticollis and neck pain localized to the ipsilateral SCM muscle Fever and dysphagia are also common The child’s head is tilted to one side and rotated to the side opposite of the facet dislocation As with rotary atlantoaxial subluxation from traumatic causes, radiographs may demonstrate the abnormality, but dynamic CT scan is diagnostic (see previous discussion) In the case of severe disease, or when there is evidence of spinal cord compression, neurosurgical consultation is necessary because cervical traction and immobilization are needed Grisel syndrome is usually mild, however, and often responds to analgesic medication, physical therapy, and a soft cervical collar In addition to treating the subluxation, antibiotics to treat an underlying bacterial infection may be needed Cervical Lymphadenitis Cervical lymphadenitis, either acute or chronic, is a common cause of neck pain and stiffness The child with this condition typically has tender swelling over the lateral aspect of the neck, with or without fever Most cases of cervical lymphadenitis are caused by S aureus or group A streptococcus Less commonly, mycobacteria and other bacteria including Bartonella henselae, the cause of cat-scratch disease, may be responsible Empirical antibiotics to treat the most common bacterial pathogens are usually sufficient therapy Screening for tuberculosis should be performed if any risk factors are present Intervertebral Disc Calcification Intervertebral disc calcification (IDC) is an uncommon, generally self-limited condition in which the nucleus pulposus of one or more intervertebral discs calcifies Both the underlying cause of the condition and acute symptoms are unknown Children typically present with 24 to 48 hours of neck pain associated with neck stiffness or torticollis; fever is often present as well The ESR is usually elevated in IDC, and leukocytosis occurs in one-third of patients Radiographs of the spine usually show the disc calcification, and CT scans help localize the calcification within the nucleus pulposus The calcification resorbs spontaneously, and the disease is generally benign and self-limited, although disc protrusion and cord compression may uncommonly occur One must distinguish infections of the spine and meningitis (see previous discussion) from IDC as symptoms and laboratory findings may overlap