Orthopaedic Issues with the neck and spine in Individuals with Down syndrome

       The most contributing factor to ortho issues in kids with Down syndrome is ligamentous laxity, also know as loose joints and ligaments.  In other words, we have some flexible kids!  The first area of concern is in the neck.  Laxities in the spine occur at different levels.  There can be abnormal motion between the head and the first vertebrae, between the first and second vertebrae (the most common), or lower in the spine.  Doctors use x-ray, CT scan, and MRI along with precise measurements to determine if the range of motion is in the normal range or not.



        Most cases in the neck are asymptomatic, meaning the patient does not feel uncomfortable.  Actually, on 1-2% of cases present with symptoms of discomfort.  The risk for this type of abnormality is neurologic or spinal cord damage.  There are rare and infrequent, 13 ever recorded, of a patient suffering sudden paralysis or death.  The treatment for this type of problem is either restricted activities or surgery.  If the range of motion is slightly above normal, the doctor will recommend restricting high risk activities, such as diving, gymnastics, boxing, football, ice hockey, rugby, soccer, wresting, and trampolines.

 This particular doctor actually said that he discourages trampolines for any child, because they are dangerous, and he often sees patients as a result of trampoline accidents.  When the range of motion, however, is too far above normal, the only course of action is surgery. 

       Cervical spine screening should be done after 5 years of age, because it is too difficult to read these tests in young children.  Also the bones of young children are not completely formed yet, and they will not be accurate before this age.  The American Academy of Pediatrics does not recommend cervical spine screening on the basis that there is no treatment for severe cervical spine abnormalities other than surgery.  The Special Olympics, however, requires that children do one before they are permitted to play sports.  Cervical spine screenings are also important to do before a child receives any anesthesia, because the neck has to be tilted back during anesthesia.  If the original results come back normal there is a low risk of developing instability later, although it is possible.  If x-rays show an abnormality in the spine, the test should be redone every 2-3 years.

       Another spinal issue that children with Down syndrome are at a higher risk for is scoliosis.  Scoliosis is a condition where the spine forms in the shape of an S.  The S shape curve of the spine will continue as the child grows. 

Scoliosis can occur for unknown reasons or as a result of cardiac surgery.  After open heart surgery, the ribs can stick together causing the spine to grow abnormally.  Children are screened at school, as well as the pediatrician.  Mild cases of scoliosis will be observed.  Braces can be used, but they are not shown to be successful treatment in children with Down syndrome. 

In severe cases, where the spine is curved over 50 degrees, and can affect the heart and lungs at 80 degrees, surgery is recommended.  Individuals with Down syndrome, however, are shown to have a higher rate of complications following the surgery. 






Next time: the hip