Atlantoaxial subluxation is predominantly found in trisomy 21. While neurological symptoms occur less frequently, fatal atlantoaxial instability with spinal cord compression has been described in trisomy 21 after minor trauma of the cervical spine. Presenting a special case we could demonstrate that atlantoaxial instability has to be ruled out in patients with trisomy 21 suffering from acute cervical spine trauma. We further recommend primary posterior fusion if the biomechanical stability of the atlantoaxial complex remains unclear after clinical and radiological exploration.
