PREOPERATIVE EVALUATION OF THE CERVICAL-SPINE IN CHILDREN WITH TRISOMY-21 - RESULTS OF A QUESTIONNAIRE STUDY

Atlantoaxial subluxation (AAS) is a form of cervical spine instability predominantly found in persons with Trisomy-21. Several case reports describe the occurrence of acute AAS in the perioperative period. Some authors have recommended cervical spine radiographs prior to elective surgery in all children with Trisomy-21. The objective of this study was to determine practice patterns of North American members of the So ciety of Pediatric Anesthesia with regard to the perioperative evaluat ion and management of potential cervical spine instability in patients with Trisomy-21. Of 171 respondents, a minority of respondents (18%) obtain preoperative radiographs and/or subspecialty consultation (9%) in asymptomatic children with Trisomy-21. For symptomatic children the majority of respondents would obtain radiographs (64%) and/or preoper ative consultation (74%). Approximately half of the respondents would attempt to maintain the head and neck in a neutral position for either asymptomatic (42%) or symptomatic (55%) patients. We conclude that th e majority of respondents base their preoperative evaluation of the ce rvical spine on the signs and symptoms of the patient. This is support ed by the literature reviewed, but is contrary to the recommendations made in some ease reports.