Outcomes of Surgical Correction of Atlantoaxial Instability in Patients with Down Syndrome: Systematic Review and Meta-Analysis

Hofler, Ryan C.; Pecoraro, Nathan C.; Jones, Gary E.

doi:10.1016/j.wneu.2019.01.267

Cited by 10 publications

(7 citation statements)

References 56 publications

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“…[23][24][25] A strength of this study was relatively large population treated by a single surgeon, while a review/meta-analysis article has been published including various backgrounds and treatments. 26 Neurological complications are occasionally unpredictable; however, they can be minimized by the development of management approaches, such as preoperative imaging, intraoperative fluoroscopic guidance or navigation, and neurophysiological monitoring. 26 One patient (case 3) showed temporary muscle weakness in the right upper and lower limbs after Halo removal at 3 months postoperatively.…”

Section: Discussionmentioning

confidence: 99%

“…26 Neurological complications are occasionally unpredictable; however, they can be minimized by the development of management approaches, such as preoperative imaging, intraoperative fluoroscopic guidance or navigation, and neurophysiological monitoring. 26 One patient (case 3) showed temporary muscle weakness in the right upper and lower limbs after Halo removal at 3 months postoperatively. However, the cause of muscle weakness could not be identified, even with image inspection.…”

Section: Discussionmentioning

confidence: 99%

“…A recent meta-analysis showed that screw fixation for pediatric AAI in patients with Down syndrome significantly reduced the loss of reduction or pseudoarthrosis. 26 Segal et al 5 reported that 10 pediatric patients with Down syndrome had cervical or O-C fusion with modified Gallie technique, resulting in 100% surgery-related complications. Among their cases, 7 of 10 patients exhibited graft absorption and/or hardware failure, which could be related to insufficient fixation.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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“…The mean age of the patients was 13.2 years, and the youngest patient was 3.8 years old. 10 , 13 Surgical treatment for upper cervical instability in skeletal dysplasia is challenging, especially in very young pediatric patients because of their small and fragile musculoskeletal structures. There are few reports of surgical treatment for upper cervical instability in patients younger than 3 years old with skeletal dysplasia due to chondrodysplasia and posttraumatic instability.…”

Section: Discussionmentioning

confidence: 99%

Posterior occipitocervical instrumented fusion for atlantoaxial instability in a 27-month-old child with Down syndrome: illustrative case

Ohba

Oda

Tanaka

et al. 2021

Journal of Neurosurgery: Case Lessons

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BACKGROUND Upper cervical spine instability is one of the most serious orthopedic problems in patients with Down syndrome. Despite the recent advancement of instrumentation techniques, occipitocervical fusion remains technically challenging in the very young pediatric population with small and fragile osseous elements. OBSERVATIONS A 27-month-old boy with Down syndrome was urgently transported to the authors’ hospital because of difficulty in standing and sitting, weakness in the upper limbs, and respiratory distress. Radiographs showed os odontoideum, irreducible atlantoaxial dislocation, and substantial spinal cord compression. Emergency posterior occipitoaxial fixation was performed using O-arm navigation. Improvement in the motor paralysis of the upper left limb was observed from the early postoperative period, but revision surgery was needed 14 days after surgery because of surgical site infection. The patient showed modest but substantial neurological improvement 1 year after the surgery. LESSONS There are several clinical implications of the present case. It warns that Down syndrome in the very young pediatric population may lead to rapid progression of spinal cord injury and life crisis. This 27-month-old patient represents the youngest case of atlantoaxial instability in a patient with Down syndrome. O-arm navigation is useful for inserting screws into very thin pedicles.

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“…One of the more frequent characteristics of DS is the generalized ligamentous hyper-laxity that occurs in about 43% of the cases [ 13 ]. As a result, people with DS may have atlantoaxial instability [ 14 , 15 ], which consists of increasing mobility between the first and the second cervical vertebrae (atlas and axes). Such instability can prevent or hinder certain movements that involve the cervical spine and neck muscles, and there must be careful monitoring regarding the possibilities of motor activities that the individual may or may not perform, remembering that, even with such atlantoaxial instability, the person must and can do physical activities, as long as the limitations related to the activity and its real possibilities are considered.…”

Section: Introductionmentioning

confidence: 99%

The Use of Virtual and Computational Technologies in the Psychomotor and Cognitive Development of Children with Down Syndrome: A Systematic Literature Review

Boato

Melo

Filho

et al. 2022

IJERPH

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Individuals with Down syndrome (DS) have numerous comorbidities due to trisomy 21. However, virtual reality-based therapy (VRT) has been used nowadays as a learning and visual motor tool in order to facilitate the development and learning process of this group. The aim of this article was to carry out an integrative review of the literature on the use of virtual and computational technologies in the stimulation of children with DS. A search was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) through single key words or their combinations using AND or OR operators: “Down syndrome” AND (“development” OR “cognition” OR “visomotor” OR “digital game” OR “virtual reality”). Eventually, 18 articles were included in our review. The games used in the research were able to stimulate, through the visual field, global motor skills, balance, body scheme and spatial organization, in addition to the learning of mathematical concepts, in order to directly influence the autonomous life activities, language skills, social skills and educational aspects of people with DS. Electronic games contribute to the teaching-learning relationship and stimulate neuropsychomotor and cognitive functions and development in children with DS.

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Outcomes of Surgical Correction of Atlantoaxial Instability in Patients with Down Syndrome: Systematic Review and Meta-Analysis

Cited by 10 publications

References 56 publications

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

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

Posterior occipitocervical instrumented fusion for atlantoaxial instability in a 27-month-old child with Down syndrome: illustrative case

The Use of Virtual and Computational Technologies in the Psychomotor and Cognitive Development of Children with Down Syndrome: A Systematic Literature Review

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