Search tips
Search criteria 


Logo of jrsocmedLink to Publisher's site
J R Soc Med. 1990 July; 83(7): 433–435.
PMCID: PMC1292731

Atlantoaxial instability in Down syndrome--guidelines for screening and detection.


A community survey was conducted in all adults with Down syndrome living in three health districts to see if there was any correlation between radiological and neurological abnormalities which could indicate the presence of atlantoaxial instability. There was no difference in the proportion of individuals with neurological abnormalities in the group with radiological abnormalities suggestive of atlantoaxial instability (6/14) compared with individuals with normal X-rays (50/123) as determined by the chi square test (0.01463: not significant). The clinical and ethical implications for screening of people with Down syndrome living in the community are discussed in view of these findings.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (689K), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Dzenitis AJ. Spontaneous atlanto-axial dislocation in a mongoloid child with spinal cord compression. Case report. J Neurosurg. 1966 Oct;25(4):458–460. [PubMed]
  • Curtis BH, Blank S, Fisher RL. Atlantoxial dislocation in Down's syndrome. Report of two patients requiring surgical correction. JAMA. 1968 Aug 5;205(6):464–465. [PubMed]
  • Hungerford GD, Akkaraju V, Rawe SE, Young GF. Atlanto-occipital and atlanto-axial dislocations with spinal cord compression in Down's syndrome: a case report and review of the literature. Br J Radiol. 1981 Sep;54(645):758–761. [PubMed]
  • Pueschel SM, Scola FH, Perry CD, Pezzullo JC. Atlanto-axial instability in children with Down syndrome. Pediatr Radiol. 1981 Feb;10(3):129–132. [PubMed]
  • Pueschel SM, Herndon JH, Gelch MM, Senft KE, Scola FH, Goldberg MJ. Symptomatic atlantoaxial subluxation in persons with Down syndrome. J Pediatr Orthop. 1984 Nov;4(6):682–688. [PubMed]
  • Alvarez N, Rubin L. Atlantoaxial instability in adults with Down syndrome: a clinical and radiological survey. Appl Res Ment Retard. 1986;7(1):67–78. [PubMed]
  • Burke SW, French HG, Roberts JM, Johnston CE, 2nd, Whitecloud TS, 3rd, Edmunds JO., Jr Chronic atlanto-axial instability in Down syndrome. J Bone Joint Surg Am. 1985 Dec;67(9):1356–1360. [PubMed]
  • Pueschel SM, Scola FH. Atlantoaxial instability in individuals with Down syndrome: epidemiologic, radiographic, and clinical studies. Pediatrics. 1987 Oct;80(4):555–560. [PubMed]
  • Collacott RA. Atlantoaxial instability in Down's syndrome. Br Med J (Clin Res Ed) 1987 Apr 18;294(6578):988–989. [PMC free article] [PubMed]
  • Coria F, Quintana F, Villalba M, Rebollo M, Berciano J. Craniocervical abnormalities in Down's syndrome. Dev Med Child Neurol. 1983 Apr;25(2):252–255. [PubMed]
  • Davidson RG. Atlantoaxial instability in individuals with Down syndrome: a fresh look at the evidence. Pediatrics. 1988 Jun;81(6):857–865. [PubMed]
  • Miller JD, Grace MG, Lampard R. Computed tomography of the upper cervical spine in Down syndrome. J Comput Assist Tomogr. 1986 Jul-Aug;10(4):589–592. [PubMed]
  • HINCK VC, HOPKINS CE. Measurement of the atlanto-dental interval in the adult. Am J Roentgenol Radium Ther Nucl Med. 1960 Nov;84:945–951. [PubMed]

Articles from Journal of the Royal Society of Medicine are provided here courtesy of Royal Society of Medicine Press