Sequelae of atlantoaxial stabilization in two patients with Down's syndrome.

Two patients with Down's syndrome and associated atlantoaxial instability with a chronically narrow spinal canal at C1-2 underwent surgical procedures in which the lesion was manipulated and posterior wiring and fusion were done. Both patients developed quadriplegia from the surgery. The authors recommend preoperative traction to reduce the deformity, then surgery with the traction maintained as a method to avoid this complication. Further, if reduction does not occur with traction, onlay grafting is recommended, avoiding any sublaminar wiring.