Atlanto-axial instability (AAI) refers to an increased flexibility between the first and second bones of the neck.  If this instability exists (about 13-14% of individuals with Down syndrome have some evidence of AAI but no symptoms), an unusual strain or stress on the neck might cause these two vertebrae to slip in opposite directions, resulting in sudden pressure on the spinal cord.  Such an event could cause significant symptoms or even death.

For children with Down syndrome whose evaluation indicates the presence of atlanto-axial instability, the following activities that put extra strain on the neck should be avoided:

• Gymnastics (especially tumbling and trampoline)
• Diving
• Swimming the butterfly stroke
• High jump
• Soccer
• Collision Sports

If your child has asymptomatic atlanto-axial instability, report any new symptoms that may be due to spinal cord injury to your doctor. These include:

• neck pain
• persistent head tilt
• intermittent or progressive weakness
• changes in gait or loss of motor skills
• loss of bowel or bladder control
• increased muscle tone in the legs
• changes in sensation in the hands or feet.

Your doctor will also monitor for any signs of spinal cord changes at your child’s yearly physical.


page history
original document - L Samson-Fang, 2002

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