Surgical strategies in the management of atlantoaxial dislocation in Down syndrome
Aims: To study the clinicoradiological features and treatment outcomes of atlantoaxial dislocation (AAD) in Down syndrome. Settings and Design: Retrospective case series. Subjects and Methods: A retrospective chart and radiology review of 9 Down syndrome patients with AAD managed at our center from...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2024-01-01
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| Series: | Journal of Craniovertebral Junction and Spine |
| Subjects: | |
| Online Access: | http://www.jcvjs.com/article.asp?issn=0974-8237;year=2024;volume=15;issue=1;spage=53;epage=60;aulast=Joseph |
| _version_ | 1797222438317064192 |
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| author | Vivek Baylis Joseph Swaminathan Ganesh Tony Varghese Panicker |
| author_facet | Vivek Baylis Joseph Swaminathan Ganesh Tony Varghese Panicker |
| author_sort | Vivek Baylis Joseph |
| collection | DOAJ |
| description | Aims: To study the clinicoradiological features and treatment outcomes of atlantoaxial dislocation (AAD) in Down syndrome.
Settings and Design: Retrospective case series.
Subjects and Methods: A retrospective chart and radiology review of 9 Down syndrome patients with AAD managed at our center from 2007 to 2018.
Statistical Analysis Used: Chi-squared/Fisher's exact test.
Results: There were 4 males and 5 females (n = 9). The median age was 14 years (interquartile range [IQR]: 7–15.5). 77.7% (7/9) of patients had severe spasticity (Nurick Grades 4 and 5). The median duration of symptoms was 9 months (IQR: 5–39). The AAD was reducible in all (n = 9) cases. Eight (88.8%) patients had os odontoideum. The mean atlantodental interval (ADI) was 8.5 mm (±2.9). T2W cord hyperintensity was seen in 66.6% (6/9). Posterior C1–2 transarticular fixation was done in 8 and occipitocervical fusion in 1 patient. Follow-up of more than 6 months (7–57 months) was available in 8/9 (88.9%) patients. There was a significant improvement in spasticity (n = 8, mean Nurick Grade 1.7 (±1.1), P = 0.003). Follow-up radiographs (n = 8) showed good reduction and fusion. A preoperative bedbound patient with poor respiratory reserve expired at 10 months following surgery. There were no other complications.
Conclusions: Posterior surgical approach for AAD in Down syndrome resulted in good alignment and fusion, with excellent clinical improvement. Patients with elevated PCO2 are poor surgical candidates and require home ventilation facility. |
| first_indexed | 2024-04-24T13:21:20Z |
| format | Article |
| id | doaj.art-499c77a1c2324c99a4123538cff0a743 |
| institution | Directory Open Access Journal |
| issn | 0974-8237 |
| language | English |
| last_indexed | 2024-04-24T13:21:20Z |
| publishDate | 2024-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Journal of Craniovertebral Junction and Spine |
| spelling | doaj.art-499c77a1c2324c99a4123538cff0a7432024-04-04T14:33:06ZengWolters Kluwer Medknow PublicationsJournal of Craniovertebral Junction and Spine0974-82372024-01-01151536010.4103/jcvjs.jcvjs_171_23Surgical strategies in the management of atlantoaxial dislocation in Down syndromeVivek Baylis JosephSwaminathan GaneshTony Varghese PanickerAims: To study the clinicoradiological features and treatment outcomes of atlantoaxial dislocation (AAD) in Down syndrome. Settings and Design: Retrospective case series. Subjects and Methods: A retrospective chart and radiology review of 9 Down syndrome patients with AAD managed at our center from 2007 to 2018. Statistical Analysis Used: Chi-squared/Fisher's exact test. Results: There were 4 males and 5 females (n = 9). The median age was 14 years (interquartile range [IQR]: 7–15.5). 77.7% (7/9) of patients had severe spasticity (Nurick Grades 4 and 5). The median duration of symptoms was 9 months (IQR: 5–39). The AAD was reducible in all (n = 9) cases. Eight (88.8%) patients had os odontoideum. The mean atlantodental interval (ADI) was 8.5 mm (±2.9). T2W cord hyperintensity was seen in 66.6% (6/9). Posterior C1–2 transarticular fixation was done in 8 and occipitocervical fusion in 1 patient. Follow-up of more than 6 months (7–57 months) was available in 8/9 (88.9%) patients. There was a significant improvement in spasticity (n = 8, mean Nurick Grade 1.7 (±1.1), P = 0.003). Follow-up radiographs (n = 8) showed good reduction and fusion. A preoperative bedbound patient with poor respiratory reserve expired at 10 months following surgery. There were no other complications. Conclusions: Posterior surgical approach for AAD in Down syndrome resulted in good alignment and fusion, with excellent clinical improvement. Patients with elevated PCO2 are poor surgical candidates and require home ventilation facility.http://www.jcvjs.com/article.asp?issn=0974-8237;year=2024;volume=15;issue=1;spage=53;epage=60;aulast=Josephatlantoaxial dislocationdown syndromeos odontoideum |
| spellingShingle | Vivek Baylis Joseph Swaminathan Ganesh Tony Varghese Panicker Surgical strategies in the management of atlantoaxial dislocation in Down syndrome Journal of Craniovertebral Junction and Spine atlantoaxial dislocation down syndrome os odontoideum |
| title | Surgical strategies in the management of atlantoaxial dislocation in Down syndrome |
| title_full | Surgical strategies in the management of atlantoaxial dislocation in Down syndrome |
| title_fullStr | Surgical strategies in the management of atlantoaxial dislocation in Down syndrome |
| title_full_unstemmed | Surgical strategies in the management of atlantoaxial dislocation in Down syndrome |
| title_short | Surgical strategies in the management of atlantoaxial dislocation in Down syndrome |
| title_sort | surgical strategies in the management of atlantoaxial dislocation in down syndrome |
| topic | atlantoaxial dislocation down syndrome os odontoideum |
| url | http://www.jcvjs.com/article.asp?issn=0974-8237;year=2024;volume=15;issue=1;spage=53;epage=60;aulast=Joseph |
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