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Safety of neck rotation for ear surgery in children with Down syndrome
N W Todd1, P J Holt, A T Allen
1Department of Otolaryngology, Emory University School of Medicine, Atlanta, Georgia, USA.
Insights
Children with Down syndrome (DS) and normal cervical spine radiographs can safely undergo ear surgery with neck rotation. This study found no increased spinal cord risk in neurologically intact DS patients during otolaryngological procedures.
Area of Science:
- Neurology
- Pediatric Otolaryngology
- Medical Imaging
Background:
- Children with Down syndrome (DS) often require otolaryngological surgery.
- Cervical spine abnormalities are common in DS, raising concerns about spinal cord safety during procedures involving neck manipulation.
- Preoperative assessment of cervical spine stability is crucial for managing these patients.
Purpose of the Study:
- To evaluate the safety of neck rotation in neurologically intact children with Down syndrome undergoing ear surgery.
- To determine if 60-degree neck rotation poses an increased risk to the spinal cord in this specific pediatric population.
Main Methods:
- Prospective study of 17 children with Down syndrome undergoing elective otolaryngological surgery.
- Somatosensory evoked potentials (SSEPs) were recorded to monitor spinal cord function.
- Cervical spine stability was assessed using plain lateral radiographs in neutral, flexed, and extended positions.
- Patients served as their own controls, with SSEPs measured before and during neck rotation.
Main Results:
- No significant changes in SSEP latency or amplitude were observed during 60-degree neck rotation in either direction.
- Statistical analysis indicated a >99.999% certainty that neurologically intact children with DS and normal radiographs were not exposed to extra risks.
- These findings suggest that neck rotation within surgical limits is safe for this patient group.
Conclusions:
- Neurologically intact pediatric patients with Down syndrome and normal cervical spine radiographs can undergo neck rotation during surgery without significant risk.
- The study supports the safety of positioning for ear surgery in children with DS when specific criteria are met.
- Further research could explore long-term outcomes and different degrees of neck mobility.
Objective:
Seek information about spinal cord safety for children with Down syndrome positioned for ear surgery.
Study Design:
Prospective consecutive patients, each serving as his or her own control.
Methods:
Somatosensory evoked potentials were recorded from 17 children who were undergoing elective otolaryngological surgery. None of the patients had neurological symptoms or physical examination findings suggesting cervical spinal cord embarrassment. Specifically, muscle tone was normal or mildly reduced globally, consistent with Down syndrome, and deep tendon reflexes were normal and not appreciably different in the upper and lower extremities. On plain lateral radiographs obtained in the neutral, flexed, and extended positions, the patients' cervical spines were normal.
Results:
When the anesthetized children had their necks placed in either right or left 60 degrees rotation, no significant change in somatosensory latency or amplitude was found. With more than 99.999% certainty, neurologically intact children with Down syndrome with normal plain cervical spine radiographs were not exposed to extra risks by 60 degrees neck rotation during surgery.
Conclusion:
Patients with Down syndrome who are neurologically intact and who have normal lateral neck radiographs do not appear at great risk with neck rotation.
