• Himanshu Champaneri and Anirban Deep Banerjee.
• Department of Neurosurgery, Institute of Neurosciences, Medanta-The Medicity Hospital, Gurgaon, Haryana, India.
• World Neurosurg. 2020 Oct 1; 142: 325-327.

BackgroundAtlantoaxial instability, a common finding in patients with Down syndrome (DS), is attributed to laxity of ligamentous structures. Cervical spondylosis identified in these patients has a pathogenesis of ligament laxity and early degeneration compared with the normal population. No cases have been reported showing affection of thoracic or lower levels.Case DescriptionTwo adults with DS presented with progressive spastic paraparesis with hypertrophy of ligamentum flavum at the lower thoracic level, causing canal stenosis and myelopathy. Degenerative changes were seen in the entire spine. Both patients improved with canal decompression.ConclusionsDegenerative changes of the spine occur earlier in DS, probably due to increased movements across the vertebrae owing to laxity in the ligaments. Routine workup of patients with DS presenting in their adult lives should keep in mind the affection of lower spinal levels. Early identification of thoracic myelopathy and lumbar canal stenosis gives a chance of cure.Copyright © 2020 Elsevier Inc. All rights reserved.

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