Cervical spine abnormalities in institutionalized adults with Down's syndrome.
Adults with Down syndrome often have unstable neck bones but no pain, so screen only when symptoms show up.
01Research in Context
What this study did
Researchers looked at neck X-rays of adults with Down syndrome living in state centers. They compared these films to X-rays from adults without disabilities.
The team measured the gap between the first neck bone and the second. They also counted signs of wear and arthritis in the cervical spine.
What they found
Adults with Down syndrome had four times more cases of a wide atlanto-odontoid gap. This gap can mean the spine is unstable.
They also showed far more bone spurs, disc narrowing, and arthritis in the neck. Yet most people had no pain or weakness.
How this fits with other research
Saad (1995) later reported one woman with Down syndrome who died after her neck bones slipped apart. That single case turns the 1993 numbers into a real-world warning.
Geurts et al. (2008), Ellingsen et al. (2014), and Dudley et al. (2019) all found low bone density in the same adult group. Together the papers show the whole spine is fragile, not just the upper neck.
The 1993 study seems to clash with later calls for routine screening. The older paper says wide gaps rarely cause symptoms, while Saad (1995) says watch for pain. The gap is methodological: the 1993 cohort had no neck complaints, so the risk looked low.
Why it matters
If you support adults with Down syndrome, do a quick neck-pain check at each visit. Ask about headaches, clumsy hands, or sudden falls. If any appear, request flexion-extension X-rays before exercise or horseback programs. Do not wait for routine screening unless new guidelines arrive.
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02At a glance
03Original abstract
The prevalence of increased anterior atlanto-odontoid distance (AAOD), a risk factor for spinal cord compression, and degenerative disease of the cervical spine (DDCS) in a population of institutionalized adults with Down's syndrome (DS) was determined and compared with age- and sex-matched 'normals' presenting to a hospital emergency department. Radiographs of the cervical spines of 99 adults with DS and 198 'normals' were compared using a standardized rating scale. The prevalence of an AAOD of 3 mm or greater, the threshold of risk from the literature, was 8% for DS cases and 2% for controls (P < 0.01). The mean AAOD for DS cases was 2.0 +/- 1 mm and for controls 1.5 +/- 0.5 mm (P < 0.01). There was a negative correlation between AAOD and age of DS cases. The prevalence of any degree of DDCS among the DS cases was 64%, the controls 39% (P < 0.001); for moderate or severe DDCS the prevalence among DS cases was 45%, controls 12% (P < 0.001). The prevalence of DDCS increased with age in both groups, but the severity of DDCS was significantly increased with age in both groups, but the severity of DDCS was significantly greater for DS individuals in all age groups. The levels of the cervical spine affected ranged from C2 to C6; the most commonly affected level was C5-C6. While DS adults are at increased theoretical risk for spinal cord compression due to increased AAOD, its clinical significance would appear to be small and to decline with age.(ABSTRACT TRUNCATED AT 250 WORDS)
Journal of intellectual disability research : JIDR, 1993 · doi:10.1111/j.1365-2788.1993.tb01284.x