Predictive Factors for the Development of Vertebral Deformities in Down's Syndrome

Abstract

There are many studies of spine pathology in people with Down Syndrome (DS), the majority of these focusing on atlantoaxial anomalies of the cervical column. There is, in contrast, much less information about other malformations such as scoliosis, kyphosis and lordosis, perhaps due to the fact that they are much less frequent pathologies with few physical and life-threatening repercussions. The aim of our study was to determine the prevalence of these spine-related malformations in a group of patients with DS and to look for factors that might predict the course of their development. We studied a total of 60 people with DS, 26 women (43.33) and 34 men (56.67%) with an average age of 39.8 ± 10.19 years, weight average of 65.4 ± 13.55 kg, and height average of 1.51 ± 0.4 metres. In all cases, we studied the different alterations of the spine following a well-established three-dimensional study protocol. We studied anthropometric data for these patients and also evaluated the other alterations which, due to their frequency, were thought to be potentially related to other spineinduced malformations: thyroidal pathologies, heart- and sight-related problems and alterations affecting the locomotive apparatus such as atlantoaxial instability, hyperlaxitude of the ligaments and deformation of the lower limbs. Forty-nine (81.67%) of the patients had some spine-related malformation, 21 (35%) had malformations related with scoliosis, 19 (31.67%) with kyphosis, 30 (50%) with lumbar hyperlordosis, and 15 (25%) suffered from 2 or more of these malformations. Sex and height did not seem to be predictive factors, but age seemed related to lumbar lordosis, with this condition being more prevalent in younger patients (p < 0.01), while dorsal kyphosis was more prevalent in older patients (p < 0.001). On crossing spinerelated malformations with other disorders, we noted that patients who suffered some form of visual pathology had a higher risk of suffering from scoliosis (p < 0.0009) and also other types of skeletal malformation (p < 0.02). The number of patients with spine-related malformations was very high in the DS study group. With time, the curvatures change: in young people bone curvature predominantly affects the lumbar hyperlordosis, while in older patients it affects the dorsal kyphosis. Patients with visual disorders and other malformations of the skeleton have a greater risk of suffering scoliosis. We think that in this population group it is very important to prevent or to reduce the column deviations.