Cervical Instability in Young Adults

Os odontoideum, trauma, and genetic conditions such as Down syndrome, Morquio disease, and pseudoachondroplasia are common causes of cervical instability in the young adult. Each underlying cause presents unique challenges to the treating physician, but a systematic approach to the problem can help guide physicians and patients in developing an individualized and appropriate treatment plan. The first step in evaluating these patients is determining if the instability is associated with any neurologic findings, as almost all patients with progressive neurologic symptoms should undergo surgical stabilization. Comparatively, asymptomatic patients or patients with only local symptoms may be treated with either careful observation or surgery, depending on the underlying diagnosis and the severity of instability. Before finalizing the treatment plan, it is important that the risk and benefits of both nonoperative and operative care are discussed, as both have been associated with significant complications.