Arch Dis Child 69:347-350 doi:10.1136/adc.69.3.347
  • Research Article

Radiological assessment of the atlantoaxial distance in Down's syndrome.

  1. M J Cremers,
  2. L Ramos,
  3. E Bol,
  4. J van Gijn
  1. Janus Jongbloed Research Centre, University of Utrecht, The Netherlands.


      People with Down's syndrome are pre-disposed to atlantoaxial instability. As part of a study to determine whether those with Down's syndrome should be screened for atlantoaxial instability before they participate in sport, a series of 279 children, aged 6 to 17 years was investigated radiologically. Lateral radiographs of the cervical spine were taken in neutral position and in flexion. The magnification factor was assessed by means of a marker attached to the nape of the neck. After correction for magnification 15% of the patients were found to have an atlantoaxial distance greater than 4 mm on the flexion film, especially boys under 11 years of age. However, sex and age together explained at most 9% of the variation in atlantoaxial distance. The maximum distance found was 6.5 mm. The disagreement between the means of first and second measurements by the same (test-retest) and by another (inter-) observer was more for those taken in the neutral position than in flexion. On a group level the results for reliability were satisfactory.