AIM To correlate the Pang and Lee class with the clinical course in a consecutive series of patients presenting with painful torticollis.METHODS Forty-seven dynamic rotational computed tomography(CT) scans in 35 patients were classified into one of the five types defined by Pang and Li, including types Ⅰ(atlantoaxial rotatopry fixation), Ⅱ(“pathologic stickiness” without crossover of C1 on C2), Ⅲ(“pathologic stickiness” with crossover of C1 on C2), Ⅳ(normal or muscular torticollis), and Ⅴ(diagnostic grey zone). The Pang and Li class was then compared with the radiologist’s report, which was graded abnormal, diagnosis of rotatory subluxation or fixation, or non-diagnostic. Medical records were reviewed and the clinical course was compared among the five subtypes.RESULTS We reviewed 47 CT scans in 35 patients, and the majority were performed without sedation. The average age was 7.7 years(4-14 years old) and associated conditions included minor trauma(20%), surgical procedures around the head and neck(29%), and Grisels syndrome(20%). Twenty-six percent of our studies fell within the pathologic spectrum(5% type 1 or rotatory fixation, 21% types 2 and 3 or rotatory subluxation), while 45% were classified as muscular torticollis(45%) and 28% fell within the diagnostic grey zone. Seven radiologists interpreted these studies, and their interpretation was discordant in 45% of cases. Clinical resolution occurred in 27 of 29 cases for which follow-up was available. One of two patients with fixed rotatory subluxation required a C1-C2 arthrodesis.CONCLUSION The Pang and Li classification characterizes a spectrum of abnormalities in rotation to facilitate communication, although the indications for dynamic CT scan should be further defined. AIM To correlate the Pang and Lee class with the clinical course in a consecutive series of patients presenting with painful torticollis. METHODS Forty-seven dynamic rotational computed tomography (CT) scans in 35 patients were classified into one of the five types defined by Pang and Li, including atlantoaxial rotatopry fixation, II (“pathologic stickiness” without crossover of Cl on C2), III (“pathologic stickiness” with crossover of Cl on C2), IV (normal or muscular torticollis) , and Ⅴ (diagnostic gray zone). The Pang and Li class was then compared with the radiologist’s report, which was graded abnormal, diagnosis of rotatory subluxation or fixation, or non-diagnostic. Medical records were reviewed and the clinical course was contest among the average age was 7.7 years (4-14 years old) and associated conditions included minor trauma (20%), surgical procedu res around the head and neck (29%), and Grisels syndrome (20%). Twenty-six percent of our studies fell within the pathologic spectrum (5% type 1 or rotatory fixation, 21% types 2 and 3 or rotatory subluxation) , while 45% were classified as muscular torticollis (45%) and 28% fell within the diagnostic gray zone. Seven radiologists examined these studies, and their interpretation was discordant in 45% of cases. Clinical Resolution occurred in 27 of 29 cases for which follow-up was available. One of two patients with fixed rotatory subluxation required a C1-C2 arthrodesis. CONCLUSION The Pang and Li classification characterizes a spectrum of abnormalities in rotation to facilitate communication, although the indications for dynamic CT scan should be further defined.