The Journal of Bone and Joint Surgery, Vol 73, Issue 10 1547-1554, Copyright © 1991 by Journal of Bone and Joint Surgery, Inc
Complications of posterior arthrodesis of the cervical spine in patients who have Down syndrome
LS Segal, DS Drummond, RM Zanotti, ML Ecker and SJ Mubarak
Department of Orthopaedic Surgery, Children's Hospital of Philadelphia, Pennsylvania 19104.
Ten patients who had Down syndrome and had had a posterior arthrodesis of
the upper cervical spine were studied. The mean age at the time of the
operation was 8.9 years, and the patients had been followed for three days
to forty-nine months. Complications related to the operation occurred in
all patients. They included infection and dehiscence at the site of the
wound, incomplete reduction of the atlanto-axial joint, instability of the
adjacent motion segment, neurological sequelae, resorption of the
autogenous bone graft, and death in the postoperative period. Resorption of
the bone graft, which occurred in six of the patients, has not previously
been reported in patients who have Down syndrome, to our knowledge. Several
theoretical mechanisms for this complication are proposed. We recommend
non-operative management for patients who have Down syndrome and
atlanto-axial instability without neurological signs or symptoms. If the
severity of symptoms necessitates a posterior arthrodesis, a high rate of
complications must be anticipated.
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