- See: Down's Syndrome:
- atlantoaxial instability is common in pts with Down's syndrome.
- significant instability requires stabilization when the spinal cord is at risk for injury.
- children interested in Special Olympics require screening;
- children should be screened w/ dynamic lateral flexion/ extension;
- normal atlanto-dens intervals in Down's syndrome may be up to 5 mm;
- Non Operative Rx:
- ADI > 5 mm:
- in asymptomatic pts avoid activities involving high-impact flexion loading on the cervical spine;
- avoidance of contact sports, high jump, and diving;
- ADI of 7-9 mm;
- implies moderate instability;
- managed by observation, cervical orthosis, & avoidance of contact sports;
- Indications for Surgical Treatment:
- significant instability;
- neurologic signs or symptoms;
- ADI > 10 mm;
- attempts at surgical stabilization of upper C-spine in children w/ Down syndrome are fraught w/ significant complications;
- fixed dislocation at junction of C-1 and C-2 are not treated by open reduction because of the high incidence of mortality.
- treatment of choice is w/ fixed dislocation is laminectomy of C-1 w/ posterior arthrodesis from occiput to C-2
Surgical treatment of symptomatic atlantoaxial subluxation in Down's syndrome.
Chronic atlanto-axial instability in Down syndrome.
Cervical-spine instability in children with Down syndrome (trisomy 21).
Complications of Posterior Arthrodesis of the Cervical Spine in Patients Who Have Down Syndrome.
Atlanto-axial dislocation in Down's syndrome: Report of 2 cases requiring surgical correction.
Atlantoaxial instability in Down syndrome: subject review. American Academy of Pediatrics Committee on Sports Medicine and Fitness.
Instability of the upper cervical spine in Down syndrome.
Reproducibility in the measurement of atlanto-occipital instability in children with Down syndrome