COMPLICATIONS AND LONG-TERM OUTCOME OF UPPER CERVICAL-SPINE ARTHRODESIS IN PATIENTS WITH DOWN-SYNDROME

Study Design. A retrospective review of 15 patients with Down syndrome who had undergone arthrodesis of the upper cervical spine for instabi lity. Objectives. To determine the complication rate and long-term out come after posterior cervical arthrodesis for upper cervical instabili ty in patients with Down syndrome. Summary of Background Data. Atlanto axial instability is common in patients with Down syndrome, and fusion of the upper cervical spine has been recommended for patients who hav e instability, with or without myelopathy. Unfortunately, the results of posterior cervical arthrodesis are not well-reported, and the natur al history of this condition is unknown. Methods. Fifteen patients wit h an average follow-up period of 74.6 months (range, 24-142 months) we re reviewed after posterior arthrodesis of the upper cervical spine. T welve patients were reexamined by the inr vestigators specifically for the purpose of this study, and three patients had long-term follow-up results available from chart review. Results. Eleven of 15 patients ( 73%) sustained 23 major complications including nonunion, loss of redu ction, neurologic deterioration, late subaxial instability, infection, and wound dehiscence. Six patients (40%) required seven reoperations to address a complication. Ultimately, 12 patients (80%) obtained osse ous union, but a definite clinical improvement was identifiable in onl y three patients, whereas two others had worsened neurologically at la test follow-up evaluation. Conclusions. A high complication rate shoul d be anticipated after posterior arthrodesis of the upper cervical spi ne in patients with Down syndrome. A cautious approach to asymptomatic instability in this condition is advocated.