Respiratory Arrest After Anterior Cervical Discectomy and Arthrodesis in a Patient with Down Syndrome. A Case Report and Review of the Literature*

Down syndrome, or trisomy 21, is a genetic disease that has been associated with many orthopaedic conditions1,3, including progressive dysplasia of the hip, slipped capital femoral epiphysis, genu valgum, dislocated patellae, planovalgus deformity, polyarticular arthropathy, and clinodactyly. Scoliosis occurs in approximately 50 percent of patients who have Down syndrome3. Abnormalties of the cervical spine have included an increased atlanto-odontoid interval (in approximately 10 percent of patients), odontoid hypoplasia, instability of the occiput and laminar defects at the first cervical level, and precocious arthritis of the midcervical level3.

Patients who have Down syndrome are at increased risk for complications after operations involving the cervical spine, as noted in several reports on posterior cervical arthrodesis for atlantoaxial instability6,10,11. Reported complications have included an increased risk of infection, wound dehiscence, resorption of bone graft, neurological injury, respiratory problems, and death. The inherent ligamentous laxity and collagen defects in patients who have Down syndrome are thought to contribute to these problems10. Death secondary to respiratory failure has been reported in association with posterior cervical arthrodesis9-11 but not, to our knowledge, in association with anterior cervical discectomy and arthrodesis.

We report the occurrence of postoperative pneumomediastinum and bilateral pneumothorax with respiratory arrest in a patient with Down syndrome who had had an anterior cervical discectomy and arthrodesis for the treatment of a large herniated disc at the level between the sixth and seventh cervical vertebrae. This complication is potentially fatal, and both intraoperative and postoperative precautions should be …

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