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A cervical flexion-extension MRI study in Down syndrome.

Andrea Romano1, Giorgio Albertini, Danilo Guida

  • 1San Raffaele Foundation Rome, Rehabilitation Facility Ceglie Messapica, Progetto Merit RBNE08E8CZ, Via della Pisana 235, 00163, Rome, Italy, andrea.romano@uniroma1.it.

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Magnetic Resonance Imaging (MRI) in flexed and extended positions can reveal crucial information about cranio-cervical instability in Down syndrome (DS) individuals. This assessment helps identify risks for spinal cord damage even in asymptomatic cases.

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Area of Science:

  • Radiology
  • Orthopedics
  • Genetics

Background:

  • Down syndrome (DS) is often associated with cranio-cervical instability.
  • Ligament laxity and hypotonia are common in DS, increasing risk.
  • Asymptomatic instability can predispose to neurological damage.

Purpose of the Study:

  • To evaluate the diagnostic value of MR imaging in neutral, flexed, and extended positions for cranio-cervical instability in Down syndrome.
  • To assess the information provided by dynamic MR imaging regarding spinal cord compression risk.

Main Methods:

  • 35 subjects with Down syndrome underwent lateral supine radiographs and MR imaging.
  • Imaging included neutral, active flexed, and extended positions.
  • Measurements focused on atlanto-axial and atlanto-occipital joint stability and subarachnoid space.

Main Results:

  • DS subjects showed reduced anterior subarachnoid space in flexed positions compared to controls.
  • Significant differences were observed in space available for the cord and ligamentous thickness.
  • Occipito-cervical instability in DS subjects correlated with greater anterior subarachnoid space reduction during flexion.

Conclusions:

  • Dynamic MR imaging in flexed and extended positions provides valuable information in DS patients with suspected cranio-cervical instability.
  • Anterior subarachnoid space and ligamentous status evaluation can identify risks of spinal cord damage.
  • This dynamic assessment is crucial for managing asymptomatic instability in Down syndrome.