Acquired Atlantoaxial Instability in Pediatric Patients with Spastic Cerebral Palsy

The development of non-traumatic C1-C2 instability in children with spastic cerebral palsy has not been reported. We present three patients with severe spastic quadriplegia and mean age 12.6 years, who developed C1-C2 instability and cervical myelopathy. The three patients demonstrated similar clinical picture with symptoms attributed to cervical myelopathy in various severity (apneic episodes, opisthotonus, alteration in muscle tone, torticollis, respiratory problems, hypereflexia, bradycardia). Patient 1 was scheduled for surgery but died due to an apneic episode. Patient 2 denied surgery, has been followed for 3 years and his neurological status remains unchanged. Patient 3 underwent occipito-cervical decompression and fusion, recovered neurologically and resumed his previous functional skills.