Romulo Augusto Andrade de Almeida¹*, Fellipe de Paula² and Andrei Fernandes Joaquim³

¹1Research Assistant II, Department of Neurosurgery, MD Anderson Cancer Center, Houston, TX, USA
²Attending Neurosurgeon, Department of Neurosurgery, Hospital Estadual de Sumaré, Universidade Estadual de Campinas, Campinas, SP, Brazil
³Associate Professor, Department of Neurosurgery, Hospital das Clínicas, Universidade Estadual de Campinas, Campinas, SP, Brazil

*Corresponding Author: Romulo Augusto Andrade de Almeida, Research Assistant II, Department of Neurosurgery, MD Anderson Cancer Center, Houston, TX, USA.

Received: October 11, 2023; Published:November 20, 2023

Abstract

Atlantoaxial instability (AAI) and subluxation may be associated with a variety of diseases. These include congenital and acquired conditions. The latter includes infectious or inflammatory processes, especially coming from the retropharyngeal space (Grisel syndrome, GS), which frequently affects children. This population presents with anatomical features and an increased frequency of upper respiratory infections, which explains the higher incidence between them. The risk for C1-C2 subluxation can be further increased by the presence of congenital ligament laxity, such as in individuals with Down syndrome. GS treatment often involves antibiotic therapy (in the setting of an acute infection) and close subluxation reduction and cervical stabilization. Surgery is reserved for highly unstable spine or failure after non-operative management. Here, we present a case of a 7-year-old child with destructive infectious AAI after a laryngeal procedure to treat subglottic stenosis. The concomitant presence of Down Syndrome (a congenital cause of AAI) led to a highly unstable spine, with neurological deficits and destruction of C1 lateral mass, that required upfront open reduction and fixation to warrant function preservation. Given the uncooperative and agitated patient, conservative management was deemed risky and would not prevent further subluxations in the future. The patient had an uneventful recovery period and remained neurologically stable at her last outpatient visit, with no signs of active infection. We concluded that the decision-making process for conservative versus surgical management for infection-related atlantoaxial instability is complex and must consider the individual characteristics and also neurological risk.

Keywords: Grisel; Syndrome; Spine; Down; Fusion; Atlantoaxial

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Citation

Citation: Romulo Augusto Andrade de Almeida., et al. “Occipitocervical Fusion for Atlantoaxial Instability Secondary to Post Laryngeal Procedure Infection in a Down Syndrome Patient - Case Report". Acta Scientific Clinical Case Reports 4.12 (2023): 30-33.

Copyright

Copyright: © 2023 Romulo Augusto Andrade de Almeida., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.