2018 CSO General Scientific Program

“Iatrogenic Cervical Spinal Cord Injury in Children with Trisomy 21”

Renata Husnudinov, George Ibrahim, Evan Propst, Nikolaus Wolter


Children with trisomy 21 are at a risk for cervical spinal cord injury due to craniocervical junction instability. Our goal was to review the literature to describe iatrogenic injury in children with trisomy 21 and provide safety recommendations.

A systematic review following the PRISMA statement was performed to capture all cases of perioperative injury in children with trisomy 21. Clinical and radiographic data extracted.

Of 348 articles screened, 16 cases of iatrogenic neurological injury were identified. Median (IQR) days to diagnosis were 30 (11.5-612.5) days. Three injuries occurred during otolaryngological surgeries, nine during sedation for intubation, one during sedation for neuroimaging, one while restraining a child. No cases resolved spontaneously. Two patients progressed to brain death. Twelve children required surgical stabilization.

Although rare, iatrogenic neurological injury is devastating and likely underreported. Thus it is imperative to maintain strict perioperative precautions for craniocervical junction instability in all children with trisomy 21.

Learning Objectives

  1. To describe both the types of cervical spinal injuries, as well as putative mechanisms associated with iatrogenic neurological injury in children with trisomy 21.
  2. To summarize perioperative safety measures for children with trisomy 21 and atlantoaxial instability.

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Scheduling Details

Posters can be seen in the Gray/Palmer/Pope Ballroom. This room will be open on Sunday, June 12 from 09:00 to 17:00, and on Monday, June 13 from 09:00 to 16:00.

Authors' Contact Details

Corresponding Author: Ms. Renata Husnudinov

Senior Author: Dr. Nikolaus Wolter

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