Chronic atlanto-axial instability in Down syndrome

We studied the radiographs of thirty-two patients with Down syndrome for evidence of atlanto-axial instability. One of the patients had instability in 1970 and seven had it in 1983. The interval between the atlas and the odontoid process in the patients who demonstrated motion at that interval radiographically averaged 2.78 millimeters in 1970 and 6.93 millimeters in 1983 (p less than 0.005). Four patients whose radiographs showed atlanto-axial motion in 1970 lost that motion by 1983, and in seven patients who did not show atlanto-axial instability in 1970 it developed by 1983. Atlanto-axial instability was more likely to develop in boys who were more than ten years old. Accessory upper-cervical ossicles became evident in three patients, none of whom had atlanto-axial motion. However, one of these three patients had an abnormally wide atlanto-axial interval.