Complications of Posterior Fusion for Atlantoaxial Instability in Children With Down Syndrome

Abstract

Objective: To clarify the complications of posterior fusion for atlantoaxial instability (AAI) in children with Down syndrome and to discuss the significance of surgical intervention.Methods: Twenty pediatric patients with Down syndrome underwent posterior fusion for AAI between February 2000 and September 2018 (age, 6.1 ± 1.9 years). C1–2 or C1–3 fusion and occipitocervical fusion were performed in 14 and 6 patients, respectively. The past medical history, operation time, estimated blood loss (EBL), duration of Halo vest immobilization, postoperative follow-up period, and intra- and perioperative complications were examined.Results: The operation time was 257.9 ± 55.6 minutes, and the EBL was 101.6 ± 77.9 mL. Complications related to the operation occurred in 6 patients (30.0%). They included 1 major complication (5.0%): hydrocephalus at 3 months postoperatively, possibly related to an intraoperative dural tear. Other surgery-related complications included 3 cases of superficial infections, 1 case of bone graft donor site deep infection, 1 case of C2 pedicle fracture, 1 case of Halo ring dislocation, 1 case of pseudoarthrosis that required revision surgery, and 1 case of temporary neurological deficit after Halo removal at 2 months postoperatively. Complications unrelated to the operation included 2 cases of respiratory infections and 1 case of implant loosening due to a fall at 9 months postoperatively.Conclusion: The complication rate of upper cervical fusion in patients with Down syndrome remained high; however, major complications decreased substantially. Improved intra- and perioperative management facilitates successful surgical intervention for upper cervical instability in pediatric patients with Down syndrome.

Risk Factors of Postoperative Cerebrospinal Fluid Leak After Craniovertebral Junction Anomalies Surgery: A Case-Control Study

“…Additionally, ligamentous laxity, weakened "holding ligaments, " and weight-bearing and age-related degenerative changes may precipitate joint instabilities. 12,29,30 With the stimulation of abnormal joint activities and inflammatory reactions, the soft tissue around the joint is hyperplasia and adhesion, making it more difficult to separate the soft tissue and the dura during the operation.…”

“…Moreover, age-related degenerative changes may precipitate progressive telescoping of the cervical spine into the skull base, resulting in an increased distance from the basion to the odontoid tip (BDI) and joint instability. 12,29,30 With aging, joint stability worsens, abnormal joint movement increases, minor local damage accu- www.e-neurospine.org 263 mulates, and repeated inflammatory reactions lead to tissue hyperplasia. In the long-term, the bone structure and surrounding soft tissue easily adhere to the dura mater, which is difficult to separate during the operation.…”

Atlantoaxial subluxation and Down syndrome: A cross-sectional analysis

“…Recent studies of AAS in the DS population have been focused primarily on surgical intervention and outcomes of specific procedures. [ 6 7 8 ] Better defining the prevalence with modern data could lead to improved guide recognition, treatment, and future research in this area. Furthermore, there are currently no universally accepted guidelines for AAS treatment strategies in patients with DS versus those without, and the consistent output of literature surrounding the topic demonstrates the need for recognition and treatment of AAS in DS patients.…”

Atlantoaxial Subluxation in a 10-Year-Old Girl With Down Syndrome: A Case Report

“…Atlantoaxial instability (AAI) is more common in children with Down syndrome than in normal children, resulting from ligament laxity and odontoid dysplasia. However, 14.6% to 22.2% of individuals with Down syndrome are affected by AAI [3]. Spitzer first reported it in 1961 [4].…”