Scholarlink

Objective <p>To evaluate surgical strategies and clinical outcomes for atlantoaxial instability/dislocation (AAI/AAD) in Down syndrome (DS) patients.</p> Methods <p>A retrospective review was conducted on 12 DS patients with AAI/AAD treated between March 2018 and June 2024. Surgical plans were tailored based on reducibility: reducible cases underwent posterior atlantoaxial/occipitocervical fusion (<i>n</i> = 8), while irreducible cases received transoral anterior release combined with posterior fixation (<i>n</i> = 4). Outcomes were assessed through complications, radiographic parameters (anterior atlantodental interval, ADI), and neurological status (JOA score).</p> Results <p>The cohort (5 males, 7 females) aged 5–28&#xa0;years (mean 11.3 ± 6.4) completed 1–6&#xa0;year follow-up. Clinical presentations included myelopathy (75.0%, 9/12) and neck pain (25.0%, 3/12). Radiographic anomalies included os odontoideum (66.7%, 8/12) and odontoid fracture (8.3%, 1/12). Postoperative ADI significantly decreased from 8.95 ± 3.19&#xa0;mm to 3.40 ± 0.81&#xa0;mm (<i>P</i> &lt; 0.05), with JOA scores improving from 10.92 ± 4.40 to 15.50 ± 2.43 (<i>P</i> &lt; 0.05). Complications occurred in 25.0% (3/12): one surgical site infection managed by debridement, one dural tear repaired intraoperatively, and one hardware displacement requiring revision. Median fusion time was 6&#xa0;months (range 4.5–16). All patients demonstrated neurological improvement except one with residual lower limb weakness.</p> Conclusion <p>DS patients with AAI/AAD frequently present with os odontoideum and spinal cord compromise, necessitating surgical intervention. Reducible dislocations may be effectively managed with posterior fusion alone, whereas irreducible cases require combined anterior–posterior approaches. Early surgical intervention is recommended for DS patients exhibiting os odontoideum with AAI/AAD due to elevated risk of progressive myelopathy.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Surgical management strategies for atlantoaxial instability/dislocation in down syndrome

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2025年7月31日

查看全文
  • Yang Gao,
  • Nanfang Xu,
  • Yinglun Tian,
  • Shenglin Wang

摘要

Objective

To evaluate surgical strategies and clinical outcomes for atlantoaxial instability/dislocation (AAI/AAD) in Down syndrome (DS) patients.

Methods

A retrospective review was conducted on 12 DS patients with AAI/AAD treated between March 2018 and June 2024. Surgical plans were tailored based on reducibility: reducible cases underwent posterior atlantoaxial/occipitocervical fusion (n = 8), while irreducible cases received transoral anterior release combined with posterior fixation (n = 4). Outcomes were assessed through complications, radiographic parameters (anterior atlantodental interval, ADI), and neurological status (JOA score).

Results

The cohort (5 males, 7 females) aged 5–28 years (mean 11.3 ± 6.4) completed 1–6 year follow-up. Clinical presentations included myelopathy (75.0%, 9/12) and neck pain (25.0%, 3/12). Radiographic anomalies included os odontoideum (66.7%, 8/12) and odontoid fracture (8.3%, 1/12). Postoperative ADI significantly decreased from 8.95 ± 3.19 mm to 3.40 ± 0.81 mm (P < 0.05), with JOA scores improving from 10.92 ± 4.40 to 15.50 ± 2.43 (P < 0.05). Complications occurred in 25.0% (3/12): one surgical site infection managed by debridement, one dural tear repaired intraoperatively, and one hardware displacement requiring revision. Median fusion time was 6 months (range 4.5–16). All patients demonstrated neurological improvement except one with residual lower limb weakness.

Conclusion

DS patients with AAI/AAD frequently present with os odontoideum and spinal cord compromise, necessitating surgical intervention. Reducible dislocations may be effectively managed with posterior fusion alone, whereas irreducible cases require combined anterior–posterior approaches. Early surgical intervention is recommended for DS patients exhibiting os odontoideum with AAI/AAD due to elevated risk of progressive myelopathy.