Elsevier

The Lancet

Volume 342, Issue 8870, 28 August 1993, Pages 511-514
The Lancet

Articles
Risk of sports activities in children with Down's syndrome and atlantoaxial instability

https://doi.org/10.1016/0140-6736(93)91644-2Get rights and content

Abstract

10-40% of children with Down's syndrome have atlantoaxial instability. These children might run the risk of spinal cord compression if they play sport. The aim of our study was to assess this presumed risk. We obtained 282 radiographs of the cervical spine from a cohort of 400 children and young adults with Down's syndrome who attended special schools and who were between 4 and 20 years old (about 25% of all such children in the Netherlands). The atlantoaxial distance was more than 4 mm in 91 children. These children were randomly assigned to two groups, with the provision that all children at any particular school were assigned to the same group. Children of one group were allowed to continue their habitual sports and exercise activities, whereas those in the other group were advised not to play "risky" sports (as defined by a panel of four experts) and not to make "risky" movements during physical education lessons. The compliance of the experimental group was good. After a year, there were no differences between the groups in scores on a functional motor scale, the frequency of neurological signs, or changes in the atlantoaxial distance. The motor function of a third group of 44 children with Down's syndrome but normal atlantoaxial distances was similar to that of children in the other two groups, as was the frequency of neurological signs. These findings suggest there is no reason to stop children with Down's syndrome from playing certain sports and no need to screen them by radiography before they take up such sports activities.

References (28)

  • N. Alvarez et al.

    Atlantoaxial instability in adults with Down syndrome: a clinical and radiological survey

    Appl Res Mental Retard

    (1986)
  • Jp Braakhekke et al.

    Cranio-vertebral pathology in Down syndrome

    Clin Neurol Neuurosurg

    (1985)
  • J. Kramer et al.

    Rheumatoid arthritis of the cervical spine

    Rheum Dis Clin N Am

    (1991)
  • J. Tishler et al.

    Dislocation of the atlas in mongolism

    Radiology

    (1965)
  • Sm Pueschel et al.

    Atlantoaxial instability in individuals with Down syndrome: epidemiologic, radiographic, and clinical studies

    Pediatrics

    (1987)
  • AD. Greenberg

    Atlanto-axial dislocation

    Brain

    (1968)
  • Committee on Sports Medicine

    Atlantoaxial instability in Down syndrome

    Pediatrics

    (1984)
  • S. Hreidarsson et al.

    Symptomatic atlantoaxial dislocation in Down syndrome

    Pediatrics

    (1982)
  • Sm Pueschel et al.

    Symptomatic atlantoaxial subluxation in persons with Down syndrome

    J Pediatr Orthop

    (1984)
  • M. Kobori et al.

    Atlantoaxial dislocation in Down syndrome: report of two cases requiring surgical correction

    Spine

    (1986)
  • V. Chaudry et al.

    Symptomatic atlanto-axial dislocation in Down's syndrome

    Ann Neurol

    (1987)
  • Mjg Cremers et al.

    Preventie van neurologische uitval als gevolg van een atlanto-axiale dislocatie bij personen met het syndroom van Down

    Hed Tijdschr Geneeskd

    (1988)
  • RG. Davidson

    Atlantoaxial instability in individuals with Down syndrome: a fresh look at the evidence

    Pediatrics

    (1988)
  • Cited by (49)

    • Craniovertebral Junction Deformities

      2016, Benzel's Spine Surgery: Techniques, Complication Avoidance and Management: Volume 1-2, Fourth Edition
    • Dental anesthesia for patients with special needs

      2012, Acta Anaesthesiologica Taiwanica
      Citation Excerpt :

      For those in whom ventilation is difficult, sedation is not recommended. Approximately 10% to 40% of children with Down syndrome have atlantoaxial instability.13 Unnecessary head extension during dental treatment should be avoided to prevent subluxation in these patients.

    View all citing articles on Scopus
    View full text