Instrumentational posterior fusion for atlanto-axial subluxation in a young child with Down's syndrome--case report.
A 3-year-old girl with Down's syndrome and myelopathy caused by atlanto-axial subluxation (AAS) was treated by C-1 to C-2 posterior fusion with a one-piece cervical device (OPCD). Instrumentation was required because the posterior arch of C-1 was too tiny and fragile to tolerate wiring. Postoperative immobilization was another major problem in this mentally retarded young child, but a hard plastic cervical corset effectively restrained the neck. She had been confined to bed by severe quadriparesis, but became able to walk without assistance 8 months after surgery. We recommend OPCD instrumentation and postoperative immobilization using a hard plastic corset for the treatment of AAS associated with Down's syndrome in young children.
Kohno
M
M
Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, Japan.
Takahashi
H
H
Yamakawa
K
K
Ishijima
B
B
Mitsui
H
H
D001268:Atlanto-Axial Joint / Q000503:physiopathology / Q000601:surgery*; D002370:Casts, Surgical; D002675:Child, Preschool; D004314:Down Syndrome / Q000150:complications*; D005260:Female; D006801:Humans; D004204:Joint Dislocations / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D010291:Paresis / Q000209:etiology; D013123:Spinal Fusion / Q000379:methods*