Cervical Instability in Downʼs Syndrome and Juvenile Rheumatoid Arthritis

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Abstract
Instability of the cervical 1-2 vertebrae is common in Down''s syndrome and may present with an insidious onset of weakness that is frequently misdiagnosed. The progressive quadriparesis that may result makes life very difficult for these children and for their caretakers. The major error in management of this patient was not recognizing the fact that if cervical 1 did not reduce on the extension radiograph relative to the odontoid, it was probably not going to reduce at surgery either. Some more gradual means of reduction should have been attempted, as was suggested. Persistent anterior subluxation of cervical 1 on cervical 2, even with a solid fusion, may be accompanied by progressive neurologic deficit.

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