Email this article Comparative characteristics of cervical sagittal balance parameters and atlantoaxial instability criteria in normal and Down syndrome children
- Authors: Kuleshov A.A.1, Nazarenko A.G.1, Sharov V.A.1, Vetrile M.S.1, Ovsyankin A.V.2, Kuzminova E.S.2, Lisyansky I.N.1, Makarov S.N.1, Strunina U.V.3
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Affiliations:
- Priorov National Medical Research Center of Traumatology and Orthopedics
- Federal Center of Traumatology, Orthopedics and Joint Replacement
- Burdenko National Scientific and Practical Center for Neurosurgery
- Issue: Vol 31, No 1 (2024)
- Pages: 55-66
- Section: Original study articles
- URL: https://journals.eco-vector.com/0869-8678/article/view/624245
- DOI: https://doi.org/10.17816/vto624245
- ID: 624245
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Abstract
BACKGROUND: Sagittal balance of the spine has received considerable development in recent years. However, most studies focused on the assessment of vertebral–pelvic parameters. The cervical spine has long received insufficient attention from researchers, but this trend has been changing. The study of cervical sagittal balance in children with Down syndrome is beneficial in approaching the preconditions of atlantoaxial instability.
AIM: To perform a comparative analysis of cervical sagittal balance parameters and atlantoaxial instability criteria in normal and Down syndrome children.
MATERIALS AND METHODS: Radiographs of the cervical spine in the neutral position in lateral projection and postural radiographs of 110 pediatric patients were analyzed retrospectively. The patients were divided into two groups: group 1 (normal), 60 children aged 4–17 years without spinal pathology, and group 2 (Down syndrome), 50 children aged 4–17 years with Down syndrome. The parameters of cervical sagittal balance (Oc-C2, Oc-C7, C1-C2, C2-C7, C2-C7H, C7S, Th1S, TIA, NT) and criteria for atlantoaxial instability (Nakamura angle, ADI, SAC-C1, SAC-C1/SAC-C4) were obtained, and data was statistically analyzed.
RESULTS: Significant differences in the parameters C7S, Th1S, and TIA increased in children with Down syndrome. These parameters are involved in cervical lordosis; however, no significant differences in cervical lordosis angles were found. Furthermore, significant differences were noted in the criteria of atlantoaxial instability ADI, SAC-C1, and SAC-C1/SAC-C4 toward their decreasing in children with Down syndrome.
CONCLUSION: In patients with Down syndrome, the indices of cervical lordosis are statistically greater than those in normal children. Moreover, the parameters of cervical lordosis in patients with Down syndrome do not differ from those in normal children. Therefore, during flexion, subcompensation of the cervical spine is observed in children with Down syndrome. Given the statistically smaller indicators ADI, SAC-C1, SAC-C1/SAC-C4, low neck muscle tone, and ligamentous hypermobility, these abnormalities can be considered as congenital predisposition factors for atlantoaxial instability in children with Down syndrome.
About the authors
Alexander A. Kuleshov
Priorov National Medical Research Center of Traumatology and Orthopedics
Email: cito-spine@mail.ru
ORCID iD: 0000-0002-9526-8274
SPIN-code: 7052-0220
MD, Dr. Sci. (Med.)
Russian Federation, MoscowAnton G. Nazarenko
Priorov National Medical Research Center of Traumatology and Orthopedics
Email: cito@cito-priorov.ru
ORCID iD: 0000-0003-1314-2887
SPIN-code: 1402-5186
MD, Dr. Sci. (Med.), professor of Russian Academy of Sciences
Russian Federation, MoscowVladislav A. Sharov
Priorov National Medical Research Center of Traumatology and Orthopedics
Author for correspondence.
Email: sharov.vlad397@gmail.com
ORCID iD: 0000-0002-0801-0639
SPIN-code: 8062-9216
Russian Federation, Moscow
Marchel S. Vetrile
Priorov National Medical Research Center of Traumatology and Orthopedics
Email: vetrilams@cito-priorov.ru
ORCID iD: 0000-0001-6689-5220
SPIN-code: 9690-5117
MD, Cand. Sci. (Med.)
Russian Federation, MoscowAnatoliy V. Ovsyankin
Federal Center of Traumatology, Orthopedics and Joint Replacement
Email: ovsjankin@rambler.ru
SPIN-code: 4417-3617
MD, Cand. Sci. (Med.)
Russian Federation, SmolenskElena S. Kuzminova
Federal Center of Traumatology, Orthopedics and Joint Replacement
Email: muxuxo@gmail.com
ORCID iD: 0000-0003-2876-6844
SPIN-code: 5992-6657
Russian Federation, Smolensk
Igor N. Lisyansky
Priorov National Medical Research Center of Traumatology and Orthopedics
Email: lisigornik@list.ru
ORCID iD: 0000-0002-2479-4381
SPIN-code: 9845-1251
MD, Cand. Sci. (Med.)
Russian Federation, MoscowSergey N. Makarov
Priorov National Medical Research Center of Traumatology and Orthopedics
Email: moscow.makarov@gmail.com
ORCID iD: 0000-0003-0406-1997
SPIN-code: 2767-2429
MD, Cand. Sci. (Med.)
Russian Federation, MoscowUliya V. Strunina
Burdenko National Scientific and Practical Center for Neurosurgery
Email: ustrunina@nsi.ru
ORCID iD: 0000-0001-5010-6661
SPIN-code: 9799-5066
Russian Federation, Moscow
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СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).