Cervical spinal cord compression in a patient with Trisomy 21

Excerpt

A six-year-old male patient with Trisomy 21 presented for C1 laminectomy and posterior occipito-cervical fusion because of worsening lower extremity weakness and generalized hypotonia. Sagittal magnetic resonance imaging (MRI) of the cranio-cervical junction (Panel A) showed widening of the atlanto-axial interval (white dotted line), thickening of the transverse ligament (white arrow), and hypoplasia of the C1 vertebral ring (black arrow). This combination resulted in an anteriorly displaced posterior C1 arch in relation to the opisthion (dorsal border of the foramen magnum) with subsequent narrowing of the spinal canal and cervical cord compression (black dotted line). The axial MRI (Panel B) showed flattening of the spinal cord (white arrows). Motor and somatosensory evoked potential monitoring after flexible bronchoscopic intubation and positioning did not reveal any significant changes compared to baseline signals. …