title: Down syndrome and scoliosis: a review of a 50-year experience at one institution.
abstract: METHODS
  Retrospective review case series.
  
  
  OBJECTIVE
  To evaluate the incidence, patterns, and treatment of scoliosis in a Down syndrome population.
  
  
  BACKGROUND
  Despite a preponderance of literature concerning cervical abnormalities in Down syndrome, there is little information concerning scoliosis in this patient group. We examined the 50-year history of treating scoliosis at our institution in patients with Down syndrome.
  
  
  METHODS
  Following institutional review board approval, chart review identified patients with Down syndrome with scoliosis. We performed a radiographic review of curve pattern, and determined results of brace and operative treatment.
  
  
  RESULTS
  A total of 379 patients were identified as having Down syndrome. There were 33 patients diagnosed with scoliosis, for an incidence of 8.7%. Mean follow-up was 4.15 years (range 0-12). The double major curve predominated with 18 (55%). Of 33 patients, 16 (49.5%) had previously undergone thoracotomy for congenital heart defects. There were 8 (24%) patients who were braced for an average of 26.5 months (range 12-63), with an average progression in brace of 10 degrees (range 0 degrees-44 degrees), 3 of whom went on to spinal fusion. There were 7 (21.2%) patients who underwent spinal fusion, including 6 posterior spinal fusions and 1 anterior spinal fusion. Four patients had complications, including 3 pseudarthroses, 4 implant failures, 3 superior junctional kyphosis, and 1 infection, for a 57% complication rate.
  
  
  CONCLUSIONS
  Scoliosis developed in 8.7% of patients with Down syndrome. There was a high rate of cardiac surgery within this population. Bracing was ineffective for the majority of the patients treated. Although surgery has a high rate of complications, there was only one patient who underwent reoperation.
authors.affiliation: Department of Orthopaedics, University of Maryland, Baltimore, MD 21201, USA. tmilbrandt@umoa.umm.edu
authors.forename: Todd A
authors.initials: TA
authors.lastname: Milbrandt
authors.forename: Charles E
authors.initials: CE
authors.lastname: Johnston
mesh_terms: D000293:Adolescent; D001915:Braces; D006348:Cardiac Surgical Procedures; D002648:Child; D002675:Child, Preschool; D004314:Down Syndrome / Q000150:complications*; D004868:Equipment Failure; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications / Q000601:surgery; D006801:Humans; D015994:Incidence; D016268:Internal Fixators / Q000009:adverse effects; D007738:Kyphosis / Q000209:etiology; D008297:Male; D019637:Orthopedic Procedures / Q000009:adverse effects; D011542:Pseudarthrosis / Q000209:etiology; D011859:Radiography; D012189:Retrospective Studies; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery*; D013530:Surgical Wound Infection / Q000209:etiology