PREVALENCE OF ATLANTO-AXIAL INSTABILITY AND ITS ASSOCIATION WITH CLINICAL SIGNS IN CHILDREN WITH DOWN SYNDROME

Autores

  • Érica Cesário Defilipo Departamento de Fisioterapia, Universidade Federal de Juiz de Fora (UFJF) - Campus Governador Valadares - Governador Valadares (MG), Brasil.
  • Priscila Cristian do Amaral Faculdade de Fisioterapia, UFJF - Juiz de Fora (MG), Brasil
  • Natália Trindade de Souza Faculdade de Fisioterapia, UFJF - Juiz de Fora (MG), Brasil
  • Carla Trevisan Martins Ribeiro Instituto Nacional da Saúde da Mulher, da Criança e do Adolescente, Fernandes Figueiras (IFF/FIOCRUZ) - Rio de Janeiro (RJ), Brasil
  • Paula Silva de Carvalho Chagas Departamento de Fisioterapia do Idoso, do Adulto e Materno-infantil, Faculdade de Fisioterapia, UFJF - Juiz de Fora (MG), Brasil
  • Flávio Augusto Teixeira Ronzani Departamento de Clínica Médica da Faculdade de Medicina, UFJF - Juiz de Fora (MG), Brasil

DOI:

https://doi.org/10.7322/jhgd.102996

Palavras-chave:

Down Syndrome, Joint Instability, Atlanto-axial Joint, X-rays, Prevalence.

Resumo

Introduction: A change in the atlanto-axial alignment in children with Down syndrome may be associated with pain, neurological disorders, high spinal cord compression and sudden death. Objective: To determine the prevalence of atlanto-axial instability in children with Down syndrome and its association with the presence of signs and symptoms of atlanto-axial instability. Methods: A cross-sectional study evaluated 21 children with Down syndrome aged between 3 and 5 years. Children who had undergone cervical spine surgery or who had diseases not associated with this syndrome were excluded. Sex, age, ethnicity of the child and the presence of signs suggestive of atlanto-axial instability, as reported by caregivers, such as neck pain, difficulty walking, weakness in the lower limbs, fatigue, difficulty with balance, urinary and fecal incontinence and projectile vomiting were studied. Children underwent a cervical spine X-ray in the lateral view in three positions: neutral, flexion and extension. When the atlas-odontoid distance was equal to or greater than 4.5 mm, atlanto-axial instability was diagnosed. Results: The prevalence of atlanto-axial instability in the studied population was 9.5%. There was no significant association revealed in the chi-square test between the signs suggestive of atlanto-axial instability and the presence of atlanto-axial instability (p > 0.05). Conclusions: Atlanto-axial instability is possibly not associated with its suggestive signs.

Referências

Schwartzman, SJ. Síndrome de Down. São Paulo: Editora Mackenzie; 2000; p.16-31.

Moreira LMA, El-Hani, CN; Gusmão, FAF Gusmão. Down syndrome and its pathogenesis: considerations about genetic determinism. Rev Bras Psiquiatr. São Paulo: 2000; 22(2):96-99. DOI: http://dx.doi.org/10.1590/S1516-

Nahas MV, Rosário AV, Nahas AB, Luza GR. Instabilidade atlanto-axial em crianças com Síndrome de Down na Grande Florianópolis: um estudo piloto. ACM Arq Catarin Med. 1991;20(4):149-154.

Barros Filho TE, Oliveira RP, Rodrigues NR, Galvão PE, Souza MP. Instabilidade atlantoaxial na Síndrome de Down. Relato de 10 casos tratados cirurgicamente. Rev Bras Ortop. 1998; 33(2): 91-94.

Boechat MCB, Silva KS, Llerena Junior JC. Instabilidade atlanto-axial na síndrome de Down: o que o radiologista precisa conhecer. Rev Imagem. São Paulo: 2006; 28(3): 171-179.

Ribeiro CTM, Sá MRC. Intervenção fisioterapêutica na Síndrome de Down. In: Associação Brasileira de Fisioterapia

Neurofuncional. Garcia CSNB, Facchinetti LD, org. Programa de Atualização em Fisioterapia Neurofuncional: Ciclo 1. (Sistema de Educação em Saúde Continuada a Distância, v.1); Porto Alegre: Artmed; 2013; p.11-46.

Sociedade de Pediatria do Estado do Rio de Janeiro (SOPERJ). Síndrome de Down. [cited 2011 July 03] Available from: .

Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Ações Programáticas Estratégicas. Manual de legislação em saúde da pessoa com deficiência. 2. ed. Brasília: Ministério da Saúde; 2006;

p.346. [cited 2012 July 07] Available from: http://bvsms.saude.gov.br/bvs/publicacoes/ legislacao_deficiencia.pdf.

Sales MLH, Ponnet L, Campos CEA, Demarzo MMP, Miranda CT. Quality of child health care in the Family Health Strategy. J Hum Growth Dev. 2013; 23(2): 151-156.

Costa A, Herrero D. Perspectives on the use of mouse models of down syndrome in translational research involving visual and motor functions. J Hum Growth Dev. 2014; 24(2):123-125.

American Academy of Pediatrics Committee on Sports Medicine. Atlantoaxial instability in Down syndrome. Pediatrics. 1984; 74(1): 152-54.

Cook JV, Pettett A, Shah K, Pablot S, Kyriou J, Fitzgerald M. Melhor prática em radiologia pediátrica: um manual para todos os serviços de radiologia. Rio de Janeiro: Editora Fiocruz; 2006; p.1001.

Merrik MDJ, Ezra E, Josef B, Hendel D, Steinberg DM, Wientroub S. Musculoskeletal problems in Down syndrome european pediatric orthopaedic society survey: the Israeli sample. J Pediatr Orthop B. Philadelphia: 2000; 9(3):185-92.

Casas DC, Andújar ALF, Marioto D, Rau LE, Pierite J, Schleder JC. Atlantoaxial instability in patients with Down’s syndrome – its relation with sports activities and the prognosis based on radiological evaluation. Coluna/Columna. Santa Catarina: 2006; 5(1):43-45.

Szpak AM, Carvalho B, Cavichiolo JB, Mocellin M, Pereira R, Rezende RK. Há necessidade de solicitar de rotina radiografia da coluna cervical para pacientes portadores de síndrome de Down antes de se realizar cirurgia otorrinolaringológica? Arq Int Otorrinolaringol. São Paulo: 2011; 15(1):16-20. http://dx.doi.org/10.1590/S1809-48722011000100002

Ribeiro CTM. Estudo da atenção fisioterapêutica para crianças portadoras de Síndrome de Down no Município do Rio de Janeiro. Tese (Doutorado) – Universidade Federal do Rio de Janeiro. Rio de Janeiro: 2010.

Bertapelli F, Gorla JI, Silva FF, Costa LT. Prevalence of obesity and the body fat topography in children and teenagers with down syndrome. J Hum Growth Dev. 2013; 23(1): 65-70.

American Academy of Pediatrics.Committee on Genetics. American Academy of Pediatrics: Health supervision for children with Down syndrome. Pediatrics. 2001;107(2):442-49.

Publicado

2015-10-20

Edição

Seção

Pesquisa Original