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The Journal of Bone and Joint Surgery 81:1741-3 (1999)
© 1999 The Journal of Bone and Joint Surgery, Inc.

Respiratory Arrest After Anterior Cervical Discectomy and Arthrodesis in a Patient with Down Syndrome. A Case Report and Review of the Literature*

SEAN E. MCCANCE, M.D.{dagger} and MICHAEL D. SMITH, M.D.{ddagger}, MINNEAPOLIS, MINNESOTA

Investigation performed at Twin Cities Spine Center, Minneapolis


   Introduction
 
Down syndrome, or trisomy 21, is a genetic disease that has been associated with many orthopaedic conditions1,3, including progressive dysplasia of the hip, slipped capital femoral epiphysis, genu valgum, dislocated patellae, planovalgus deformity, polyarticular arthropathy, and clinodactyly. Scoliosis occurs in approximately 50 percent of patients who have Down syndrome3. Abnormalties of the cervical spine have included an increased atlanto-odontoid interval (in approximately 10 percent of patients), odontoid hypoplasia, instability of the occiput and laminar defects at the first cervical level, and precocious arthritis of the midcervical level3.

Patients who have Down syndrome are at increased risk for complications after operations involving the cervical spine, as noted in several reports on posterior cervical arthrodesis for atlantoaxial instability6,10,11. Reported complications have included an increased risk of infection, wound dehiscence, resorption of bone graft, neurological injury, respiratory problems, and death. The inherent ligamentous laxity and collagen defects in patients . . . [Full Text of this Article]


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