{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T16:36:44Z","timestamp":1790095004754,"version":"4.0.1"},"reference-count":22,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims:<\/jats:title>\n                    <jats:p>To study the clinicoradiological features and treatment outcomes of atlantoaxial dislocation (AAD) in Down syndrome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Settings and Design:<\/jats:title>\n                    <jats:p>Retrospective case series.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Subjects and Methods:<\/jats:title>\n                    <jats:p>A retrospective chart and radiology review of 9 Down syndrome patients with AAD managed at our center from 2007 to 2018.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Statistical Analysis Used:<\/jats:title>\n                    <jats:p>Chi-squared\/Fisher\u2019s exact test.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      There were 4 males and 5 females (n = 9). The median age was 14 years (interquartile range [IQR]: 7\u201315.5). 77.7% (7\/9) of patients had severe spasticity (Nurick Grades 4 and 5). The median duration of symptoms was 9 months (IQR: 5\u201339). The AAD was reducible in all (n = 9) cases. Eight (88.8%) patients had os odontoideum. The mean atlantodental interval (ADI) was 8.5 mm (\u00b12.9). T2W cord hyperintensity was seen in 66.6% (6\/9). Posterior C1\u20132 transarticular fixation was done in 8 and occipitocervical fusion in 1 patient. Follow-up of more than 6 months (7\u201357 months) was available in 8\/9 (88.9%) patients. There was a significant improvement in spasticity (n = 8, mean Nurick Grade 1.7 (\u00b11.1),\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.003). Follow-up radiographs (n = 8) showed good reduction and fusion. A preoperative bedbound patient with poor respiratory reserve expired at 10 months following surgery. There were no other complications.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>\n                      Posterior surgical approach for AAD in Down syndrome resulted in good alignment and fusion, with excellent clinical improvement. Patients with elevated PCO\n                      <jats:sub>2<\/jats:sub>\n                      are poor surgical candidates and require home ventilation facility.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/jcvjs.jcvjs_171_23","type":"journal-article","created":{"date-parts":[[2024,3,13]],"date-time":"2024-03-13T07:03:03Z","timestamp":1710313383000},"page":"53-60","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":5,"title":["Surgical strategies in the management of atlantoaxial dislocation in Down syndrome"],"prefix":"10.4103","volume":"15","author":[{"given":"Vivek Baylis","family":"Joseph","sequence":"first","affiliation":[{"name":"Department of Neurological Sciences, Christian Medical College, Ranipet Campus, Vellore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Swaminathan","family":"Ganesh","sequence":"additional","affiliation":[{"name":"Department of Neurological Sciences, Christian Medical College, Ranipet Campus, Vellore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tony Varghese","family":"Panicker","sequence":"additional","affiliation":[{"name":"Department of Neurological Sciences, Christian Medical College, Ranipet Campus, Vellore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2024,3,13]]},"reference":[{"key":"R1-20240904","doi-asserted-by":"crossref","first-page":"610","DOI":"10.5435\/00124635-200610000-00003","article-title":"Down syndrome in children: The role of the orthopaedic surgeon","volume":"14","author":"Caird","year":"2006","journal-title":"J Am Acad Orthop Surg"},{"key":"R2-20240904","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1542\/peds.74.1.152","article-title":"Committee on sports medicine. 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