Presentation
The patient presented with 5 days history of non-traumatic neck pain, with limited range of movement, a new clicking sound, and no neurological signs. Past medical history of Down syndrome, with no known spinal condition.
Patient Data
Severe disruption of all cervical spine alignment lines: anterior vertebral, posterior vertebral, spinolaminar and posterior spinous line. The atlanto-axial interval is enlarged at 11mm. No prevertebral soft tissue swelling. Findings are in keeping with severe anterior atlanto-axial subluxation.
Post-operative study, with interval C1 / C2 fusion. No metalwork complications.
Case Discussion
This was a first presentation of atlanto-axial subluxation on a patient with Down syndrome, a known predisposing factor. This highlights the need for imaging in patients with Down syndrome, even if no prior known spinal disease or preceding trauma. The patient went on to have a successful surgical fixation.
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