1
|
Alfhmi S, Sejeeni N, Alharbi K, Alharbi R, Malayoo B. Atlantoaxial Subluxation in a 10-Year-Old Girl With Down Syndrome: A Case Report. Cureus 2023; 15:e43955. [PMID: 37746433 PMCID: PMC10514675 DOI: 10.7759/cureus.43955] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2023] [Indexed: 09/26/2023] Open
Abstract
Down syndrome is the most common inherited chromosomal disorder caused by trisomy 21. Atlantoaxial instability (AAI) is more common in children with Down syndrome, resulting from ligament laxity and odontoid dysplasia. We report the case of a 10-year-old girl with Down syndrome submental. She came to the ER with a history of abnormal gait for one week and was admitted with a case of ataxia for investigations. Moreover, we discovered that she had atlantoaxial subluxation, which was treated surgically.
Collapse
Affiliation(s)
- Sumaiah Alfhmi
- Pediatric Medicine, Maternity and Children Hospital, Makkah, SAU
| | - Nevein Sejeeni
- Pediatric Medicine, Maternity and Children Hospital, Makkah, SAU
| | | | - Rahaf Alharbi
- Faculty of Medicine, Umm Al-Qura University, Makkah, SAU
| | - Baraah Malayoo
- Faculty of Medicine, Umm Al-Qura University, Makkah, SAU
| |
Collapse
|
2
|
Sport Preparticipation Screening for Asymptomatic Atlantoaxial Instability in Patients With Down Syndrome. Clin J Sport Med 2020; 30:293-295. [PMID: 30119085 DOI: 10.1097/jsm.0000000000000642] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Down syndrome (DS) is a clinical syndrome comprising typical facial features and various physical and intellectual disabilities due to extra genetic material on chromosome 21, with one in every 1000 babies born in the United Kingdom affected. Patients with Down syndrome are at risk of atlantoaxial instability (AAI). Although AAI can occur in other conditions, such as rheumatoid arthritis, this position statement deals specifically with patients with DS and asymptomatic AAI. Atlantoaxial instability, also referred to as atlantoaxial subluxation, is defined as increased movement between the first (atlas) and second (axial) cervical vertebra joint articulation, the atlantoaxial joint. Atlantoaxial instability is reported to occur in 6.8% to 27% of the DS population, although this varies depending on the age of the patients whom you are screening. Less than 1% to 2% of these patients are then thought to later develop symptomatic AAI, although the natural history and progression of AAI is not well understood. The risks associated with AAI are neurological injury from excessive movement of the cervical vertebra impinging on and then damaging the spinal cord, although the risk of this during sporting activities is extremely rare. Clearly, physical activity and sports participation for patients with DS has many biological, psychological, and social benefits, and the Faculty of Sport and Exercise Medicine (FSEM), United Kingdom, wishes to promote safe physical activity and sport for all. The FSEM, United Kingdom, has therefore produced a statement regarding sport preparticipation screening for asymptomatic AAI in patients with DS.
Collapse
|
3
|
Tu A, Melamed E, Krieger MD. Dynamic MRI in the Evaluation of Atlantoaxial Stability in Pediatric Down Syndrome Patients. Pediatr Neurosurg 2019; 54:12-20. [PMID: 30677764 DOI: 10.1159/000495788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 11/23/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Down syndrome is the most common inherited disorder. Some patients develop atlantoaxial instability. Existing screening guidelines were developed prior to availability of MRI. We present predictors for deficit using dynamic MRI of the craniocervical junction. METHODS A retrospective review of Down syndrome patients from 2001 to 2015 was carried out. Patients were considered symptomatic if they had clinical deficits or signal change on MRI. Measurements were taken at the atlantoaxial junction and structural abnormalities noted. Analysis was performed with SPSS. RESULTS A total of 36 patients were included. Patients averaged 93 months of age with a follow-up of 57 months. No asymptomatic patients developed myelopathy during follow-up. During dynamic imaging, symptomatic patients had greater changes in space available for the cord (SAC) (5.2 vs. 2.7 mm; p < 0.001) and atlantodental interval (ADI) (2.8 vs. 1.3 mm; p = 0.04). These patients were also more likely to have a bony anomaly (50 vs. 13%; p = 0.03). CONCLUSION This study characterizes the range of motion seen on dynamic MRI and provides parameters that can be used to distinguish patients at risk for neurologic injury. Changes greater than 3 mm in ADI or 5 mm in SAC during dynamic MRI or any bony abnormality warrants further investigation. Patients without these features may be able to avoid an unnecessary intervention.
Collapse
Affiliation(s)
- Albert Tu
- Children's Hospital of Los Angeles, Los Angeles, California, USA, .,Children's Minnesota, St. Paul, Minnesota, USA,
| | - Edward Melamed
- Children's Hospital of Los Angeles, Los Angeles, California, USA
| | - Mark D Krieger
- Children's Hospital of Los Angeles, Los Angeles, California, USA
| |
Collapse
|
4
|
A case report of atlanto-axial instability in a Down Syndrome patient. Spinal Cord Ser Cases 2018; 4:106. [DOI: 10.1038/s41394-018-0139-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 11/07/2018] [Accepted: 11/12/2018] [Indexed: 11/08/2022] Open
|
5
|
Hofler RC, Heiferman DM, Molefe A, LeDuc R, Johans SJ, Rosenblum JD, Nockels RP, Jones GA. Morphologic variations of the second cervical vertebra in Down syndrome compared with age-matched peers. J Neurosurg Spine 2018; 30:175-181. [PMID: 30497148 DOI: 10.3171/2018.8.spine18750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 08/08/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEAtlantoaxial instability is an important cause of pain and neurological dysfunction in patients with Down syndrome (DS), frequently requiring instrumented fusion of the upper cervical spine. This study provides a quantitative analysis of C2 morphology in DS patients compared with their peers without DS to identify differences that must be considered for the safe placement of instrumentation.METHODSA retrospective chart review identified age-matched patients with and without DS with a CT scan of the cervical spine. Three-dimensional reconstructions of these scans were made with images along the axis of, and perpendicular to, the pars, lamina, facet, and transverse foramen of C2 bilaterally. Two of the authors performed independent measurements of anatomical structures using these images, and the average of the 2 raters' measurements was recorded. Pedicle height and width; pars axis length (the distance from the facet to the anterior vertebral body through the pars); pars rostrocaudal angle (angle of the pars axis length to the endplate of C2); pars axial angle (angle of the pars axis length to the median coronal plane); lamina height, length, and width; lamina angle (angle of the lamina length to the median coronal plane); and transverse foramen posterior distance (the distance from the posterior wall of the transverse foramen to the tangent of the posterior vertebral body) were measured bilaterally. Patients with and without DS were compared using a mixed-effects model accounting for patient height.RESULTSA total of 18 patients with and 20 patients without DS were included in the analysis. The groups were matched based on age and sex. The median height was 147 cm (IQR 142-160 cm) in the DS group and 165 cm (IQR 161-172 cm) in the non-DS group (p < 0.001). After accounting for variations in height, the mean pars rostrocaudal angle was greater (50.86° vs 45.54°, p = 0.004), the mean transverse foramen posterior distance was less (-1.5 mm vs +1.3 mm, p = 0.001), and the mean lamina width was less (6.2 mm vs 7.7 mm, p = 0.038) in patients with DS.CONCLUSIONSPatients with DS had a steeper rostrocaudal trajectory of the pars, a more posteriorly positioned transverse foramen posterior wall, and a narrower lamina compared with age- and sex-matched peers. These variations should be considered during surgical planning, as they may have implications to safe placement of instrumentation.
Collapse
Affiliation(s)
| | | | - Ayrin Molefe
- 2Clinical Research Office, Loyola University Chicago Health Sciences Division, Chicago; and
| | - Ryan LeDuc
- 3Stritch School of Medicine, Loyola University Chicago, Illinois
| | | | | | | | | |
Collapse
|
6
|
Capone GT, Chicoine B, Bulova P, Stephens M, Hart S, Crissman B, Videlefsky A, Myers K, Roizen N, Esbensen A, Peterson M, Santoro S, Woodward J, Martin B, Smith D. Co-occurring medical conditions in adults with Down syndrome: A systematic review toward the development of health care guidelines. Am J Med Genet A 2017; 176:116-133. [PMID: 29130597 DOI: 10.1002/ajmg.a.38512] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 08/30/2017] [Accepted: 09/26/2017] [Indexed: 11/06/2022]
Abstract
Adults with Down syndrome (DS) represent a unique population who are in need of clinical guidelines to address their medical care. The United States Preventive Service Task Force (USPSTF) has developed criteria for prioritizing conditions of public health importance with the potential for providing screening recommendations to improve clinical care. The quality of existing evidence needed to inform clinical guidelines has not been previously reviewed. Using the National Library of Medicine (NLM) database PubMed, we first identified 18 peer reviewed articles that addressed co-occurring medical conditions in adults with DS. Those conditions discussed in over half of the articles were prioritized for further review. Second, we performed detailed literature searches on these specific conditions. To inform the search strategy and review process a series of key questions were formulated a priori. The quality of available evidence was then graded and knowledge gaps were identified. The number of participating adults and the design of clinical studies varied by condition and were often inadequate for answering all of our key questions. We provide data on thyroid disease, cervical spine disease, hearing impairment, overweight-obesity, sleep apnea, congenital heart disease, and osteopenia-osteoporosis. Minimal evidence demonstrates massive gaps in our clinical knowledge that compromises clinical decision-making and management of these medically complex individuals. The development of evidence-based clinical guidance will require an expanded clinical knowledge-base in order to move forward.
Collapse
Affiliation(s)
- George T Capone
- Kennedy Krieger Institute, Down Syndrome Clinic & Research Center, Baltimore, Maryland
| | - Brian Chicoine
- Advocate Adult Down Syndrome Center, Park Ridge, Illinois
| | - Peter Bulova
- Montefiore Hospital, Adult Down Syndrome Clinic, Pittsburgh, Pennsylvania
| | - Mary Stephens
- Christiana Care Health System, Adult Down Syndrome Clinic, Wilmington, Delaware
| | - Sarah Hart
- Duke University Medical Center, Durham, North Carolina
| | | | - Andrea Videlefsky
- The Adult Disability Medical Home, Urban Family Practice, Marietta, Georgia
| | | | - Nancy Roizen
- Rainbow Babies and Children's Hospital, Cleveland, Ohio
| | - Anna Esbensen
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Jane and Richard Thomas Center for Down Syndrome, Cincinnati, Ohio
| | - Moya Peterson
- University of Kansas Medical Center, Adults with Down Syndrome Specialty Clinic, Kansas City, Kansas
| | | | - Jason Woodward
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Jane and Richard Thomas Center for Down Syndrome, Cincinnati, Ohio
| | - Barry Martin
- Division of General Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - David Smith
- Children's Hospital of Wisconsin, Down Syndrome Clinic of Wisconsin, Milwaukee, Wisconsin
| | | |
Collapse
|
7
|
Arumugam A, Raja K, Venugopalan M, Chandrasekaran B, Kovanur Sampath K, Muthusamy H, Shanmugam N. Down syndrome-A narrative review with a focus on anatomical features. Clin Anat 2016; 29:568-77. [PMID: 26599319 DOI: 10.1002/ca.22672] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 11/19/2015] [Indexed: 12/14/2022]
Abstract
Down syndrome (DS) is the most common aneuploidy of chromosome 21, characterized by the presence of an extra copy of that chromosome (trisomy 21). Children with DS present with an abnormal phenotype, which is attributed to a loss of genetic balance or an excess dose of chromosome 21 genes. In recent years, advances in prenatal screening and diagnostic tests have aided in the early diagnosis and appropriate management of fetuses with DS. A myriad of clinical symptoms resulting from cognitive, physical, and physiological impairments caused by aberrations in various systems of the body occur in DS. However, despite these impairments, which range from trivial to fatal manifestations, the survival rate of individuals with DS has increased dramatically from less than 50% during the mid-1990s to 95% in the early 2000s, with a median life expectancy of 60 years reported recently. The aim of this narrative review is to review and summarize the etiopathology, prenatal screening and diagnostic tests, prognosis, clinical manifestations in various body systems, and comorbidities associated with DS. Clin. Anat. 29:568-577, 2016. © 2015 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Ashokan Arumugam
- Department of Physical Therapy, College of Applied Medical Sciences, Majmaah University, Kingdom of Saudi Arabia
| | - Kavitha Raja
- JSS College of Physiotherapy, Mysore, Karnataka, India
| | | | | | - Kesava Kovanur Sampath
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Hariraja Muthusamy
- Department of Physical Therapy, College of Applied Medical Sciences, Majmaah University, Kingdom of Saudi Arabia
| | | |
Collapse
|
8
|
Craniovertebral Junction Instability in Adult Patients with Down Syndrome. World Neurosurg 2015; 83:334-6. [DOI: 10.1016/j.wneu.2014.04.075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 04/30/2014] [Indexed: 11/20/2022]
|
9
|
El-Khouri M, Mourão MA, Tobo A, Battistella LR, Herrero CFP, Riberto M. Prevalence of Atlanto-Occipital and Atlantoaxial Instability in Adults with Down Syndrome. World Neurosurg 2014; 82:215-8. [DOI: 10.1016/j.wneu.2014.02.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Revised: 01/23/2014] [Accepted: 02/08/2014] [Indexed: 10/25/2022]
|
10
|
Wadhwa R, Mummaneni PV. High cervical instability in adult patients with Down syndrome. World Neurosurg 2014; 83:332-3. [PMID: 24802847 DOI: 10.1016/j.wneu.2014.04.072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 04/30/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Rishi Wadhwa
- Department of Neurological Surgery, University of California, San Francisco, California, USA
| | - Praveen V Mummaneni
- Department of Neurological Surgery, University of California, San Francisco, California, USA.
| |
Collapse
|
11
|
Abstract
Craniovertebral dislocation is uncommon, but its diagnosis is important taking into account the potential severity of the neurologic complications. A number of causes are known; the most common are Down syndrome, rheumatoid arthritis, Paget's disease, other metabolic bone diseases, and craniocervical trauma. Down's syndrome is a relatively common clinical condition but craniovertebral subluxation is only observed in a small percentage of patients. About half of all cervical spine injuries affect the atlanto-occipital region and C2 vertebra. In rheumatoid arthritis, craniocervical dislocation occurs in up to 40% of patients with severe disease. In Paget's disease, involvement of the craniovertebral region occurs in about 30% of all cases. The clinical neurologic syndrome is characterized by local pain, features of upper spinal cord and medullary compression, positive Lhermitte phenomenon, syncope associated with neck flexion, vertebral artery obstruction or dissection leading to stroke, and asymmetrical lower cranial nerve palsies. Neuroimaging is essential to confirm the clinical diagnosis and to categorize severity. The treatment of this disorder is usually surgical, but traction and external immobilization is relevant in some cases. Specific conditions may require additional treatments such as radiotherapy, antibiotics, or chemotherapy.
Collapse
|
12
|
Hwang SW, Jea A. A review of the neurological and neurosurgical implications of Down syndrome in children. Clin Pediatr (Phila) 2013; 52:845-56. [PMID: 23743011 DOI: 10.1177/0009922813491311] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Down syndrome is the most commonly encountered chromosomal translation and has been associated with significant congenital abnormalities in various organ systems. Along with classic facial findings, it may involve the gastroenterologic, cardiac, ophthalmologic, endocrine, immunologic, orthopedic, or neurologic systems. With respect to the neurological system, a higher incidence of moyamoya, seizure disorders, strokes, and spinal ligamentous laxity has been described in these children. We have summarized the current available literature with respect to children who have Down syndrome and the varying neurological pathologic entities associated to help health care providers better understand these patients.
Collapse
Affiliation(s)
- Steven W Hwang
- Department of Neurosurgery, Tufts Medical Center, Floating Hospital for Children, Boston, MA 02111, USA.
| | | |
Collapse
|
13
|
Abstract
These guidelines are designed to assist the pediatrician in caring for the child in whom a diagnosis of Down syndrome has been confirmed by chromosome analysis. Although a pediatrician's initial contact with the child is usually during infancy, occasionally the pregnant woman who has been given a prenatal diagnosis of Down syndrome will be referred for review of the condition and the genetic counseling provided. Therefore, this report offers guidance for this situation as well.
Collapse
|
14
|
Abstract
Abstract
CHILDREN WITH DOWN syndrome may have occipitocervical and atlantoaxial instability. To prevent neurologic injury during athletic competitions, such as the Special Olympics, radiographic cervical spine screening was established in 1983 as a prerequisite for participation in some events. This review discusses the biomechanics underlying upper cervical instability in children with Down syndrome, the evolution of cervical spine screening protocols, and current opinion regarding management for children with Down syndrome and upper cervical instability.
Collapse
Affiliation(s)
- Todd C. Hankinson
- Department of Neurosurgery, Columbia University, College of Physicians and Surgeons, Neurological Institute of New York, New York, New York
| | - Richard C.E. Anderson
- Department of Neurosurgery, Columbia University, College of Physicians and Surgeons, Neurological Institute of New York, New York, New York
| |
Collapse
|
15
|
Abstract
Skeletal dysplasias are a heterogeneous group of disorders in which there is abnormal cartilage and bone formation, growth, and remodeling. There are more than 200 described skeletal dysplasias. Skeletal dysplasias can affect the spine in various ways, with attendant neurosurgical implications for diagnosis and treatment. Craniocervical junction abnormalities, atlantoaxial subluxation, and kyphoscoliotic deformity are among the common spinal problems that are found in certain skeletal dysplasias.
Collapse
Affiliation(s)
- Debbie Song
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI 48109-0338, USA
| | | |
Collapse
|
16
|
Abstract
Individuals with Down syndrome (DS) derive measurable physiologic and psychologic benefits from participation in physical activities and sports. Physicians in the position of evaluating these individuals and providing guidance in regard to their competitive or recreational physical activities need to be aware of the physiologic and anatomic concerns specific to this population. Effective screening and evaluation by a physician, accompanied with clearly communicated guidelines for specific activities, can provide an individual with DS the opportunity to safely participate in sports and recreational physical activity.
Collapse
Affiliation(s)
- Osman N Sanyer
- University of Utah Department of Family and Preventive Medicine, 375 Chipeta Way, Suite A, Salt Lake City, UT 84108, USA.
| |
Collapse
|
17
|
|
18
|
Ali FE, Al-Bustan MA, Al-Busairi WA, Al-Mulla FA, Esbaita EY. Cervical spine abnormalities associated with Down syndrome. INTERNATIONAL ORTHOPAEDICS 2006; 30:284-9. [PMID: 16525818 PMCID: PMC2532127 DOI: 10.1007/s00264-005-0070-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/17/2005] [Revised: 11/21/2005] [Accepted: 11/22/2005] [Indexed: 10/24/2022]
Abstract
Atlantoaxial instability (AAI) affects 10-20% of individuals with Down syndrome (DS). The condition is mostly asymptomatic and diagnosed on radiography by an enlarged anterior atlanto-odontoid distance. Symptomatic AAI, which affects 1-2% of individuals with DS, manifests with spinal cord compression. Cervical spondylosis, which is common in DS, also has the potential for cord damage but it has received less attention because paediatric populations were mostly studied. Forty-four Kuwaiti subjects with DS, whose ages were > or = 15 years, were evaluated clinically and radiographically. Lateral neck radiographs were taken in the neutral and flexion positions. Asymptomatic AAI was diagnosed in eight subjects (18%) and congenital anomalies of C1-2 were found in five (12%). Five patients had AAI in flexion only while three patients had it in both views. Three patients with AAI had odontoid anomalies contributing to the condition. When assessing AAI, the posterior atlanto-odontoid distance has to be considered because it indicates the space available for the cord. Cervical spondylosis was noted in 16 (36%) subjects. Degenerative changes increased with age, occurred earlier than in the normal population, and affected mostly the lower cervical levels. Half the patients with AAI had cervical spondylosis, a comorbidity that puts the cord at increased risk.
Collapse
|
19
|
|
20
|
Doyle JS, Lauerman WC, Wood KB, Krause DR. Complications and long-term outcome of upper cervical spine arthrodesis in patients with Down syndrome. Spine (Phila Pa 1976) 1996; 21:1223-31. [PMID: 8727197 DOI: 10.1097/00007632-199605150-00016] [Citation(s) in RCA: 53] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective review of 15 patients with Down syndrome who had undergone arthrodesis of the upper cervical spine for instability. OBJECTIVES To determine the complication rate and long-term outcome after posterior cervical arthrodesis for upper cervical instability in patients with Down syndrome. SUMMARY OF BACKGROUND DATA Atlantoaxial instability is common in patients with Down syndrome, and fusion of the upper cervical spine has been recommended for patients who have instability, with or without myelopathy. Unfortunately, the results of posterior cervical arthrodesis are not well reported, and the natural history of this condition is unknown. METHODS Fifteen patients with an average follow-up period of 74.6 months (range, 24-142 months) were reviewed after posterior arthrodesis of the upper cervical spine. Twelve patients were reexamined by the investigators specifically for the purpose of this study, and three patients had long-term follow-up results available from chart review. RESULTS Eleven of 15 patients (73%) sustained 23 major complications including nonunion, loss of reduction, neurologic deterioration, late subaxial instability, infection, and wound dehiscence. Six patients (40%) required seven reoperations to address a complication. Ultimately, 12 patients (80%) obtained osseous union, but a definite clinical improvement was identifiable in only three patients, whereas two others had worsened neurologically at latest follow-up evaluation. CONCLUSIONS A high complication rate should be anticipated after posterior arthrodesis of the upper cervical spine in patients with Down syndrome. A cautious approach to asymptomatic instability in this condition is advocated.
Collapse
Affiliation(s)
- J S Doyle
- Department of Orthopaedic Surgery, Shriner's Hospitals for Crippled Children, Greenville, South Carolina, USA
| | | | | | | |
Collapse
|
21
|
Saad KF. A lethal case of atlantoaxial dislocation in a 56-year-old woman with Down's syndrome. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 1995; 39 ( Pt 5):447-449. [PMID: 8555722 DOI: 10.1111/j.1365-2788.1995.tb00550.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
A case of fatal atlantoaxial dislocation is reported in a 56-year-old woman with Down's syndrome. The literature indicates such a case to be a rarity; however, this may be a result of the predominance of younger age samples. The implications of this are discussed.
Collapse
Affiliation(s)
- K F Saad
- Kidderminster General Hospital, England
| |
Collapse
|
22
|
Jenkins R, Brooksbank D, Miller E. Ageing in learning difficulties: the development of health care outcome indicators. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 1994; 38 ( Pt 3):257-264. [PMID: 8061471 DOI: 10.1111/j.1365-2788.1994.tb00393.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
A system of outcome indicators for the health and social care of ageing people with learning disabilities is required to ensure that clinicians, planners, purchasers and policy makers can monitor and evaluate the impact of health and social care. As longevity is increasing in people with learning disabilities, special problems are found in the physical health, psychological health and social wellbeing of the elderly. This paper reviews theoretical aspects of outcome indicators, and uses the various classes of outcome measures available to draw up a system of indicators for clinicians, researchers and planners. This paper represents the personal view of the authors, prepared for a conference in August 1992.
Collapse
Affiliation(s)
- R Jenkins
- Department of Health, London, England
| | | | | |
Collapse
|
23
|
Litman RS, Perkins FM. Atlantoaxial subluxation after typanomastoidectomy in a child with trisomy 21. Otolaryngol Head Neck Surg 1994; 110:584-6. [PMID: 8208577 DOI: 10.1177/019459989411000619] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- R S Litman
- Department of Anesthesiology, Strong Memorial Hospital, Rochester, NY 14642
| | | |
Collapse
|
24
|
Roy A, Roy M, Butler AC. Atlantoaxial Instability in Monozygotic Twins with Down's Syndrome. Med Chir Trans 1993; 86:296. [PMID: 8505757 PMCID: PMC1294011 DOI: 10.1177/014107689308600519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- A Roy
- Chelmsley Hospital, Birmingham
| | | | | |
Collapse
|
25
|
Selby KA, Newton RW, Gupta S, Hunt L. Clinical predictors and radiological reliability in atlantoaxial subluxation in Down's syndrome. Arch Dis Child 1991; 66:876-8. [PMID: 1830735 PMCID: PMC1793243 DOI: 10.1136/adc.66.7.876] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Clinical signs and symptoms that might predict atlantoaxial subluxation were studied prospectively in 135 of 180 children with Down's syndrome aged 6-14 years who form the Hester Adrian Research Centre cohort. Lateral radiographs of the cervical spine were taken in flexed, extended, and neutral positions, and the percentage of abnormalities in each view was 14, 10, and 10%, respectively. Gait was the only significant clinical predictor. The relative risk of having an abnormal neck radiograph with an abnormal gait was 2.91 (95% confidence interval (CI) 1 to 8). The sensitivity was 50% and the specificity 81%. Nineteen children had repeat radiographs to assess the reliability of radiological diagnosis. Six had abnormalities; five of 19 (26%) had an abnormality on the first radiograph, and four of 19 (21%) had an abnormality on a second radiograph, but only three (15%) had an abnormality on both occasions in any view (95% CI 0 to 25). We conclude that radiographs of the cervical spine are unreliable at identifying atlantoaxial subluxation in children with Down's syndrome, and we failed to identify any reliable clinical predictor.
Collapse
Affiliation(s)
- K A Selby
- Royal Manchester Children's Hospital
| | | | | | | |
Collapse
|