Atlantoaxial instability (AAI) in Down’s syndrome
المؤلف:
FRANK GARVEY AND JACKY VINCENT
المصدر:
Caring for People with Learning Disabilities
الجزء والصفحة:
P124-C8
2025-10-20
196
Atlantoaxial instability (AAI) in Down’s syndrome
AAI denotes increased mobility at the articulation of the first and second cervical vertebrae (atlantoaxial joint). The causes of AAI are not well under stood but may include abnormalities of the ligaments that maintain the integrity of the articulation, bony abnormalities of the cervical vertebrae, or both.
In its mildest form, AAI is asymptomatic and is diagnosed using x-rays. Symptomatic AAI results from subluxation (excessive slippage that is severe enough to injure the spinal cord) or from dislocation at the atlantoaxial joint.
Approximately 15 per cent of youths with Down’s syndrome have AAI. Almost all are asymptomatic. The neurological manifestations of atlantoaxial instability include tiredness, difficulty in walking, abnormal gait, neck pain, limited neck mobility and head tilting to one side (torticollis), poor coordination, clumsiness, and sensory deficits. Nearly all of the individuals who have experienced serious injury to the spinal cord have had a long history reflecting the above outlined clinical picture. There is no evidence that participating in sporting activities increases the risk of cervical spine injuries (Department of Health 1995). In the event of an individual’s requiring general anesthesia, nursing and medical staff should be alerted to the possibility of atlantoaxial instability so as to provide the necessary support when moving and handling the unconscious patient (Casey et al. 1995). In a few instances, this may be severe enough to traumatize the spinal cord, with resultant sensory and motor neuronal damage (Davidson 1988), loss of control of bowel or bladder, and spasticity.
Most importantly, symptomatic AAI is apparently rare in individuals with Down’s syndrome. Carers and students must learn the symptoms of AAI, outlined above, that indicate the need to seek immediate medical care.
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