Prevalência de instabilidade atlantoaxial e sua associação com sinais clínicos em crianças com síndrome de down

A change in the atlanto-axial alignment in children with Down syndrome may be associated with pain, neurological disorders, high spinal cord compression and sudden death OBJECTIVE: To determine the prevalence of atlanto-axial instability in children with Down syndrome and its association with the presence of signs and symptoms of atlanto-axial instability METHODS: A cross-sectional study evaluated 21 children with Down syndrome aged between 3 and 5 years. Children who had undergone cervical spine surgery or who had diseases not associated with this syndrome were excluded. Sex, age, ethnicity of the child and the presence of signs suggestive of atlanto-axial instability, as reported by caregivers, such as neck pain, difficulty walking, weakness in the lower limbs, fatigue, difficulty with balance, urinary and fecal incontinence and projectile vomiting were studied. Children underwent a cervical spine X-ray in the lateral view in three positions: neutral, flexion and extension. When the atlas-odontoid distance was equal to or greater than 4.5 mm, atlanto-axial instability was diagnosed RESULTS: The prevalence of atlanto-axial instability in the studied population was 9.5%. There was no significant association revealed in the chi-square test between the signs suggestive of atlanto-axial instability and the presence of atlanto-axial instability (p >0.05) CONCLUSIONS: Atlanto-axial instability is possibly not associated with its suggestive signs. A alteracao no alinhamento atlantoaxial em criancas com sindrome de Down pode estar associada a dor, transtornos neurologicos, compressao medular alta e ate a morte subita OBJETIVO: Determinar a prevalencia de instabilidade atlantoaxial em criancas com sindrome de Down e verificar a associacao entre a instabilidade atlantoaxial e a presenca de sinais e sintomas desta alteracao METODO: Estudo transversal que avaliou 21 criancas com sindrome de Down com idade entre 3 e 5 anos. Nao foram incluidas criancas que realizaram cirurgia cervical e com patologias nao associadas a sindrome. Foram investigados sexo, idade e raca da crianca e a presenca de sinais sugestivos de instabilidade atlantoaxial segundo relato dos cuidadores, como dor no pescoco, dificuldade de andar, fraqueza em membros inferiores, cansaco, dificuldade de equilibrio, incontinencia fecal e urinaria e vomito em jato. As criancas foram submetidas a radiografia da coluna cervical em perfil em tres posicoes: neutro, flexao e extensao, sendo considerada instabilidade atlantoaxial quando a distância atlas-odontoide era igual ou maior que 4,5 milimetros RESULTADOS: A prevalencia de instabilidade atlantoaxial na populacao estudada foi de 9,5%. Nao foi verificada, pelo teste Qui-quadrado, associacao estatisticamente significativa entre os sinais sugestivos e a presenca de instabilidade atlantoaxial (p-valor>0,05) CONCLUSAO: A instabilidade atlantoaxial possivelmente nao tem associacao com os seus sinais sugestivos.