[Perioperative Management for Atlantoaxial Rotatory Fixation in a Child with Down Syndrome]

Atlantoaxial instability is a relatively common com- plication in children with Down syndrome. Atlantoaxial rotatory fixation (AARF) is a condition in which the atlantoaxial joint is fixed at the position of rotation deformity accompanied by pain. We report a 10-year-old girl with Down syndrome who developed AARF postoperatively. No symptoms had been present prior to surgery. During anesthesia induction and then surgery, her neck was maintained at rest However, there was intense body movement during extubation. On postoperative day 8, she experi- enced sudden onset of neck pain and neck exercise restrictions, and a neck sprain was thus diagnosed. The symptoms gradually improved with analgesic administration and rehabilitation, but complete recovery was not obtained. Therefore, on postoperative day 23, cervical radiography and computed tomography were performed. These imaging studies revealed AARF. She was given conservative treatment We conclude that preoperative evaluation and peri- operative protection of the cervical spine are important Considering the mental retardation characteristic of Down syndrome, it is essential to diagnose and treat AARF at the earliest possible stage based on careful observation.