CERVICAL SPINE X RAY DOWN'S SYNDROME PROFESSIONAL

Does the person’s neck flexion allow the chin to rest on their chest? Yes/No.Does the person have poor head/neck muscular control? Yes/No.Does the person show evidence of progressive Myopathy? Yes/No.The 3 screening questions consist of (11): This is also supported by Down Syndrome Association (12). This is similar to British Gymnastics, who have developed their own information sheet and undertake their own screening questions, with no radiological screening (11). For the neurological examination, Morton et al advise (8) checking for gait disturbance, neck movements, tendon reflexes, and plantar responses.Selby et al (10) conclude that both plain x-ray and physical examination are insensitive for screening for AAI in DS patients.General Practitioner (GP)/Family Physician.

CERVICAL SPINE X RAY DOWN'S SYNDROME PROFESSIONAL

For sport pre-participation assessment, a focused history and neurological examination of DS patients should be undertaken by an appropriately qualified medical professional or chartered physiotherapist (6) (4), with the preference for the professional to be someone who cares for the patient regularly, on an ongoing basis and is therefore aware of their baseline function (6), e.g.Plain lateral cervical spine radiography (including neutral, flexion and/or extension views) cannot therefore be recommended as a screening test for asymptomatic AAI in sport (10) (6) (8) (2) (4).Īlternative sport pre-participation screening techniques for asymptomatic AAI.Symptomatic AAI is rare in DS patients (2).Obtaining plain lateral cervical spine radiography and then the necessary measurements for AAI is technically difficult (6).AAI diagnosis on plain xray can also change as the patient gets older (4): in 1986 Morton et al (8) followed up 90 children aged between 4-19 yo for 5 years after screening them with plain cervical x-ray and overall the AAI prevalence decreased at follow-up.There are diagnostic inconsistencies surrounding asymptomatic AAI on plain radiography, with, for example, Morton et al (8) reporting that it occurs at 4mm whilst other authors 3mm (9) (10) and some 4.5mm (5).They concluded that there is no evidence to support plain radiography screening for asymptomatic AAI. They found no difference between the groups in terms of motor or neurological function. Cremers et al (6) followed up 91 asymptomatic AAI patients for 1 year after screening them with lateral cervical spine radiography, letting them either participate in unrestricted sport or restricting their sporting activities.Plain lateral cervical spine radiography as a screening test for asymptomatic AAI The FSEM, UK has therefore produced a statement regarding sport pre-participation screening for asymptomatic AAI in DS patients. Clearly physical activity and sports participation for DS patients has many biological, psychological and social benefits (7) and the Faculty of Sport and Exercise Medicine (FSEM), United Kingdom (UK) wish to promote safe physical activity and sport for all. The risks associated with AAI are neurological injury from excessive movement of the cervical vertebra impinging on and then damaging the spinal cord although the risk of this during sporting activities is extremely rare (2) (6). Less than 1-2% (3) (5) of these patients are then thought to later develop symptomatic AAI although the natural history and progression of AAI is not well understood (2). AAI is reported to occur in 6.8 – 27% of the DS population (3) (4) although this varies depending on the age of the patients which you are screening. AAI in DS patients is due to a combination of ligament laxity and bony abnormalities of the atlantoaxial joint. DS patients are at risk of atlanto-axial instability (AAI) although AAI can occur in other conditions, such as rheumatoid arthritis, but this position statement deals specifically with DS patients and asymptomatic AAI.ĪAI, also referred to as atlanto-axial subluxation, is defined as increased movement between the 1 st (atlas) and 2 nd (axial) cervical vertebra joint articulation, the atlantoaxial joint (2). Down Syndrome (DS) is a clinical syndrome comprising of typical facial features and various physical and intellectual disabilities due to extra genetic material on chromosome 21, with one in every 1,000 babies born in the UK affected (1).

Cervical spine x ray down's syndrome