Neurologic injury occurs from cord compression between the odontoid and posterior arch of C1.Associated fractures of the skull and/or facial bones are common.Anterior atlantoaxial dislocations may be, but are not necessarily, associated with a fracture of the dens (~50% at autopsy).Almost all atlantoaxial dislocations involve forward movement of C1 on C2 posterior dislocation is extremely rare.The pathologic mechanism involves hyperflexion of the neck.Traumatic atlantoaxial subluxation/dislocation usually results from a motor vehicle collision in which an unrestrained occupant’s head strikes the windshield or dashboard.While chronic atlantoaxial dislocations which occur in the above diseases may be severe yet asymptomatic, acute atlantoaxial dislocations are more often symptomatic and can be life-threatening.Other arthridities-such as psoriasis and lupus Morquio syndrome-secondary to odontoid hypoplasia or aplasia Grisel syndrome-atlantoaxial subluxation associated with inflammation of adjacent soft tissues of the neck Rheumatoid arthritis-from laxity of the ligaments and destruction of the articular cartilage 1993 342:511–4.Non-traumatic Conditions Associated with Increase inĭown syndrome-due to laxity of the transverse ligament Risk of sports activities in children with Down’s syndrome and atlanto-axial instability. A longitudinal study of atlanto-dens relationship in asymptomatic individuals with Down syndrome. Topic review and treatment recommendations. Down syndrome and craniovertebral instability. Computerized tomography in persons with Down syndrome and atlantoaxial instability. Instability of the upper cervical spine in Down syndrome. Normal occipitovertebral relationships on lateral radiographs of supine subjects. Radiologic diagnosis of traumatic occipitovertebral dissociation: 1. Occipito-atlantal translation in Down’s syndrome. Screening of children with down syndrome for atlantoaxial (C1-2) instability: another contentious health question. Specific entities affecting the craniocervical region: Down’s syndrome. Reassessment of the craniocervical junction: normal values on CT. Rojas CA, Bertozzi JC, Martinez CR, Whitlow J. Symptomatic atlantoaxial subluxation in persons with down syndrome.

Pueschel SM, Herndon JM, Gelch MM, Senft KE, Scola FH, Goldberg MJ. Should children with down syndrome be screened for atlantoaxial instability. Atlantoaxial instability in down syndrome: subject review. Committee on sports medicine and fitness. 2010 66:A32–8.Īmerican Academy of Pediatrics.

Craniovertebral junction abnormalities in Down syndrome. Symptomatic atlanto-axial instability in an adolescent with trisomy 21 (Down’s syndrome). 2012 37:E269–77.ĭedlow ER, Siddiqi S, Fillipps DJ, Kelly MN, Nackashi JA, Tuli SY. Review of cervical spine anomalies in genetic syndromes. McKay SD, Al-Omari A, Tomlinson LA, Dormans JP. Changes in the cranio-cervical junction in Down’s syndrome. In DS subjects with asymptomatic cranio-cervical instability, anterior subarachnoidal evaluation and ligamentous status could add new information about the risk of spinal cord damage.Īmato C, Moschini M, Cioni M, Bianco M. In DS subjects with occipito-cervical instability, the anterior subarachnoidal space reduction was significantly reduced in flexed position. Both, space available for cord and ligamentous thickness showed significant differences between DS subjects and healthy controls. ResultsĪ significant reduction of anterior subarachnoid space in flexed position was evident in DS subjects compared to healthy controls in neutral and flexed positions. For evaluating the atlanto-axial and atlanto-occipital joint stability, multiple measurements were calculated. Each patient underwent lateral supine radiographs and MR imaging in the neutral, active flexed and extended positions. All the subjects were affected by hypotonic status and ligament laxity established by clinical evaluation, but were asymptomatic about focal neurological symptoms due to medullar damage caused by cranio-cervical instability. Ethics committee approval was granted and a signed informed consent was obtained from the parents. Methodsīetween 20, 35 subjects with DS were recruited in the study. To assess what kind of information MR examination in flexed and extended positions provides in Down syndrome subjects with suspected cranio-cervical instability.

Cervical spine x ray down's syndrome