title: Safety of neck rotation for ear surgery in children with Down syndrome.
abstract: OBJECTIVE
  Seek information about spinal cord safety for children with Down syndrome positioned for ear surgery.
  
  
  METHODS
  Prospective consecutive patients, each serving as his or her own control.
  
  
  METHODS
  Somatosensory evoked potentials were recorded from 17 children who were undergoing elective otolaryngological surgery. None of the patients had neurological symptoms or physical examination findings suggesting cervical spinal cord embarrassment. Specifically, muscle tone was normal or mildly reduced globally, consistent with Down syndrome, and deep tendon reflexes were normal and not appreciably different in the upper and lower extremities. On plain lateral radiographs obtained in the neutral, flexed, and extended positions, the patients' cervical spines were normal.
  
  
  RESULTS
  When the anesthetized children had their necks placed in either right or left 60 degrees rotation, no significant change in somatosensory latency or amplitude was found. With more than 99.999% certainty, neurologically intact children with Down syndrome with normal plain cervical spine radiographs were not exposed to extra risks by 60 degrees neck rotation during surgery.
  
  
  CONCLUSIONS
  Patients with Down syndrome who are neurologically intact and who have normal lateral neck radiographs do not appear at great risk with neck rotation.
authors.affiliation: Department of Otolaryngology, Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: N W
authors.initials: NW
authors.lastname: Todd
authors.forename: P J
authors.initials: PJ
authors.lastname: Holt
authors.forename: A T
authors.initials: AT
authors.lastname: Allen
mesh_terms: D000293:Adolescent; D001268:Atlanto-Axial Joint / Q000502:physiology; D001269:Atlanto-Occipital Joint / Q000502:physiology; D002648:Child; D002675:Child, Preschool; D004314:Down Syndrome; D004423:Ear / Q000601:surgery*; D017558:Elective Surgical Procedures; D005073:Evoked Potentials, Somatosensory / Q000502:physiology; D005260:Female; D006801:Humans; D007223:Infant; D007431:Intraoperative Complications / Q000517:prevention & control*; D008297:Male; D009809:Odontoid Process / Q000502:physiology; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D011187:Posture; D011446:Prospective Studies; D011859:Radiography; D013117:Spinal Cord Compression / Q000000981:diagnostic imaging / Q000517:prevention & control*