Bouchard Maryse, Bauer Jennifer M, Bompadre Viviana, Krengel Walter F
Division of Orthopaedics, Department of Surgery, The Hospital for Sick Children, University of Toronto, 555 University Avenue, m/s S107, Toronto, ON, M5G1X8, Canada.
Department of Orthopedics and Sports Medicine, Seattle Children's Hospital, 4800 Sand Point Way OA.9.120, Seattle, WA, 98105, USA.
Spine Deform. 2019 Nov;7(6):950-956. doi: 10.1016/j.jspd.2019.01.012.
Retrospective evaluation of cervical spine images from 2006-2012 for the purposes of "screening" children with Down syndrome for instability.
To determine whether a full series of cervical spine images including flexion/extension lateral (FEL) radiographs was needed to avoid missing upper cervical instability.
The best algorithm, measurements, and criteria for screening children with Down syndrome for upper cervical instability are controversial. Many authors have recommended obtaining flexion and extension views. We noted that patients who require surgical stabilization due to myelopathy or cord compression typically have grossly abnormal radiographic measurements on the neutral upright lateral (NUL) cervical spine radiograph.
The atlanto-dental interval, space available for cord, and basion axial interval were measured on all films. The Weisel-Rothman measurement was made in the FEL series. Clinical outcome of those with abnormal measurements were reviewed. Sensitivity, specificity, and positive and negative predictive values of NUL and FEL radiographs for identifying clinically significant cervical spine instability were calculated.
A total of 240 cervical spine series in 213 patients with Down syndrome between the ages of 4 months and 25 years were reviewed. One hundred seventy-two children had an NUL view, and 88 of these patients also had FEL views. Only one of 88 patients was found to have an abnormal atlanto-dental interval (≥6 mm), space available for cord at C1 (≤14 mm), or basion axial interval (>12 mm) on an FEL series that did not have an abnormal measurement on the NUL radiograph. This patient had no evidence of cord compression or myelopathy.
Obtaining a single NUL radiograph is an efficient method for radiographic screening of cervical spine instability. Further evaluation may be required if abnormal measurements are identified on the NUL radiograph. We also propose new "normal" values for the common radiographic measurements used in assessing risk of cervical spine instability in patients with Down syndrome.
Level IV.
对2006年至2012年的颈椎影像进行回顾性评估，以“筛查”唐氏综合征患儿是否存在颈椎不稳定。
确定是否需要一系列完整的颈椎影像，包括屈伸位侧位（FEL）X线片，以避免漏诊上颈椎不稳定。
筛查唐氏综合征患儿上颈椎不稳定的最佳算法、测量方法和标准存在争议。许多作者建议拍摄屈伸位片。我们注意到，因脊髓病或脊髓受压而需要手术稳定治疗的患者，其颈椎中立位直立侧位（NUL）X线片上的影像学测量通常明显异常。
在所有胶片上测量寰齿间距、脊髓可用空间和基底轴间距。在FEL系列中进行Weisel-Rothman测量。对测量异常者的临床结局进行回顾。计算NUL和FEL X线片在识别具有临床意义的颈椎不稳定方面的敏感性、特异性、阳性和阴性预测值。
共回顾了213例年龄在4个月至25岁之间的唐氏综合征患者的240个颈椎系列影像。172名儿童拍摄了NUL位片，其中88名患者还拍摄了FEL位片。在FEL系列中，88名患者中只有1名的寰齿间距（≥6mm）、C1水平的脊髓可用空间（≤14mm）或基底轴间距（>12mm）异常，而其NUL X线片测量无异常。该患者无脊髓受压或脊髓病的证据。
拍摄一张NUL X线片是颈椎不稳定影像学筛查的有效方法。如果NUL X线片测量异常，则可能需要进一步评估。我们还提出了用于评估唐氏综合征患者颈椎不稳定风险的常见影像学测量的新“正常”值。
IV级。
