Overview
Overview
At all ages people with Down syndrome are at increased risk for neurological problems caused by cervical spine disorders. In childhood, craniovertebral instability is the predominant issue, occurring in 7– 27% of children with Down syndrome. Symptomatic instability only occurs in 1-2%, but potentially devastating consequences are well documented.
There is no good evidence that asymptomatic individuals are more at risk of cervical spine injury than the general population. Those with Down syndrome should not be barred from any sporting activities unless there are symptoms or signs to suggest instability .Clinical screening criteria have been developed by the British Gymnastics Association for specialised sports such as trampolining.
Identifying those at risk is not straightforward. Routine X ray screening is not recommended as X rays have poor predictive value and can be difficult to interpret.
Emphasis is therefore on recognizing potential warning symptoms of craniovertebral instability, including
Clinicians should be aware of signs and symptoms such as:
Symptomatic AAI is an emergency and requires prompt referral to acute services.
Anaesthetists and ambulance personnel should take into account that unconscious children with Down syndrome may be at increased risk of cervical spine injury, especially if they have warning signs of potential craniovertebral instability. Pre-operative X rays in asymptomatic children are not indicated.
Last updated: April 2024 Dr Richard Harrison
DSMIG Guidance
Cervical spine disorders: craniovertebral instability
Guideline for Basic Essential Medical Surveillance
DSMIG’s evidence-based guideline for basic essential medical surveillance.
Last updated: 2012
Presentations at DSMIG Meetings
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Additional Resources
Neck Instability – Down’s Syndrome Association Health Series leaflet
About neck problems – Down’s Syndrome Association easy read leaflet
Last updated 2020
British Gymnastics Atlanto Axial Information pack 2021
Book Chapter – Musculoskeletal manifestations
in
Down Syndrome – Current Perspectives
Edited by Richard Newton , Shiela Puri and Liz Marder