Safety of neck rotation for ear surgery in children with Down syndrome

Objective: Seek information about spinal cord safety for children with Down syndrome positioned for ear surgery. Study Design: Prospective consecutive patients, each serving as his or her own control. Methods: Somatosensory e voked potentials were recorded hom 17 children who were undergoing elective otolaryngological surgery. None of the patients had neurological symptoms or physical examination findings suggesting cervical spinal cord embarrassm ent, Specifically, muscle tone was normal or mildly reduced globally, consi stent with Down syndrome, and deep tendon reflexes were normal and not appr eciably different in the upper and lower extremities. On plain lateral radi ographs obtained in the neutral, flexed, and extended positions, the patien ts' cervical spines were normal. Results: When the anesthetized children ha d their necks placed in either right or left 60 degrees rotation, no signif icant change in somatosensory latency or amplitude was found. With more tha n 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. Conclusion: Patients with Down sy ndrome who are neurologically intact and who have normal lateral neck radio graphs do not appear at great risk with neck rotation.