Neck flexion and extension in children with Down syndrome: a somatosensory study

The cervical spine in Down syndrome patients is often lax, at least at radiographic imaging, and the risk of spinal cord embarrassment is increased. This study was performed to obtain information that would help identify patients at risk for this problem and reduce the risk of endotracheal intubation and other surgical procedures in patients with Down syndrome. Somatosensory evoked potential studies were performed in 15 consecutive children who were undergoing elective otolaryngic surgery. None had neurologic symptoms or the physical examination finding of cervical spinal cord embarrassment, and their cervical spines were considered normal by plain radiographs obtained in the neutral, flexed, and extended positions. No significant change in latency (P = .16) or amplitude (P = .19) was found when the anesthetized children had their necks placed in either full flexion or full extension. With more than 90% certainty, the authors believe that children with Down syndrome who have "normal" plain cervical spine radiographs are exposed to no extra risks from neck flexion or extension during surgery.