CASI CLINICI   

Chirurgia 2015 February;28(1):43-7

Copyright © 2015 EDIZIONI MINERVA MEDICA

lingua: Inglese

Non-fixed (mobile) rotational atlantoaxial subluxation in Down Syndrome

Grant R. A., Quon J. L., Diluna M. L.

Department of Neurosurgery, Section of Pediatric Neurosurgery, Yale University School of Medicine, New Haven, CT, USA

AIM: Craniocervical junction abnormalities are common in children with Down Syndrome secondary to ligamentous laxity or malformation of C1 and C2. Excess mobility of this articulation results in atlantoaxial instability and at an extreme can result in dislocation. We review the presentation, diagnostic work-up and management of rotary atlantoaxial subluxation in a population predisposed to developing this condition.
METHODS: In this report, we describe a six year-old child who was found to have non-fixed rotatory atlantoaxial subluxation presenting with neck discomfort, followed by torticollis, after undergoing general anesthesia for a minor surgical procedure.
RESULTS: Imaging demonstrating that his anteriolisthesis was purely rotary, reducing at neutral, and that the transverse atlantal and alar ligaments were intact. He was treated conservatively with a cervical collar for 6 weeks with complete resolution of his mobile rotatory atlantoaxial subluxation.
CONCLUSION: Conservative management is appropriate for patients who present with rotatory atlantoaxial subluxation and no neurological sequelae. However, should neurological sequelae be present, halo immobilization, and even potentially posterior cervical fixation will likely be warranted to protect the neural elements.