Atlanto-Occipital and Atlanto-Axial Instability in Children with Down Syndrome

Kattan, Hoda; McDonald, Peter J.

doi:10.5144/0256-4947.1996.56

Cited by 3 publications

(2 citation statements)

References 19 publications

(17 reference statements)

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“…The atlanto‐occipital instability is not mentioned in the AAP guidelines . The reasons are unclear to the authors, but we speculate that plain radiographs are inadequate to detect the occipital structures and would be better evaluated with a CT scan . In our Institution, the Wackenheim line is used (Figure ).…”

Section: How To Evaluate the Atlanto‐occipital Instability And The Atmentioning

confidence: 83%

Cervical instability in patients with Trisomy 21: The eternal gamble

Bertolizio

Saint‐Martin

Ingelmo

2018

Pediatric Anesthesia

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Patients with Trisomy 21 are particularly at risk of cervical instability due to ligamentous laxity and osseous abnormalities. Up to 30% of Trisomy 21 patients are affected by atlanto-axial or atlanto-occipital instability, but only 1%-2% of cases are symptomatic. The radiologic assessment of cervical instability is not unanimously considered mandatory. The dynamic cervical spine radiograph is the most common screening tool for ruling out cervical spine instability in patients with Trisomy 21, and it is often requested before surgery. Several measurements have been investigated to assess the presence and degree of cervical instability; however, no conclusive recommendations have been forthcoming. In daily practice, many anesthesiologists may provide anesthesia via such means as laryngoscopy and tracheal intubation during surgery, without any radiological investigations before surgery. This review focuses on the diagnostic and prognostic measures available to evaluate the presence and degree of cervical instability in patients with Trisomy 21 and to propose practical recommendations to be applied in clinical practice.

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Section: How To Evaluate the Atlanto‐occipital Instability And The Atmentioning

confidence: 83%

Cervical instability in patients with Trisomy 21: The eternal gamble

Bertolizio

Saint‐Martin

Ingelmo

2018

Pediatric Anesthesia

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“…The extended distance between the rear surface of the frontal arcus of the C1 cervical vertebra and the anterior surface of C2 cervical vertebra dens (anterior atlanto-odontoid distance, AAOD) indicates the occurrence of AAI. During X-ray examination, the distance is measured in a neutral position with forward flexion of the cervical spine and, as suggested by some reports, in a position of hyperextension ( Ferguson et al, 1997 ; Harley and Collins, 1994 ; Kattan and McDonald, 1996 ; Roy et al, 1993 ).…”

Section: Introductionmentioning

confidence: 99%

Atlanto-Axial Instability in People with Down’s Syndrome and its Impact on the Ability to Perform Sports Activities – A Review

Myśliwiec

Posłuszny²,

Saulicz

et al. 2015

Journal of Human Kinetics

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Atlanto-axial instability (AAI) is a developmental anomaly often occurring in persons with Down's syndrome (DS). According to various reports, AAI affects from 6.8 to 27% of the population with DS. The aim of this review was to illustrate the issue of AAI with regard to the progressively changing state of scientific knowledge. The extended distance between the rear surface of the frontal arcus of the C1 cervical vertebra and the anterior surface of C2 cervical vertebra dens (anterior atlanto-odontoid distance, AAOD) indicates the occurrence of AAI and is detectable through Xray examination. Hypoplasia of the C2 dens, also detectable through X-ray examination, is another suggested risk factor for AAI. According to current data, the methodology of taking measurements is inconsistent, which leads to errors in interpretation. As research focusing on AAI was progressing, new data emerged from other studies on persons with DS, suggesting that neurological symptoms in persons with DS that indicated the occurrence of spinal cord compression were an important factor in medical imaging detection of AAI. One of the main arguments supporting this thesis is that in isolated cases

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