Surgical Treatments for Cervical Spondylotic Myelopathy Associated with Athetoid Cerebral Palsy

  • Lee, Yong-Jeon (Department of Neurosurgery Our Lady of Mercy Hospital Catholic University) ;
  • Chung, Dong-Sup (Department of Neurosurgery Our Lady of Mercy Hospital Catholic University) ;
  • Kim, Jong-Tae (Department of Neurosurgery Our Lady of Mercy Hospital Catholic University) ;
  • Bong, Ho-Jin (Department of Neurosurgery Our Lady of Mercy Hospital Catholic University) ;
  • Han, Young-Min (Department of Neurosurgery Our Lady of Mercy Hospital Catholic University) ;
  • Park, Young-Sup (Department of Neurosurgery Our Lady of Mercy Hospital Catholic University)
  • Published : 2008.06.13

Abstract

Objective : To evaluate the clinical characteristics and surgical outcomes of the patients with cervical spondylotic myelopathy associated with athetoid cerebral palsy. Methods : The authors reviewed the clinical and neurodiagnostic findings, surgical managements and outcomes in six consecutive patients with cervical spondylotic myelopathy associated with athetoid cerebral palsy who had been treated with surgical decompression and fusion procedures between January 1999 and December 2005. The mean age of the 6 patients (four women and two men) at the time of surgery was 42.8 years (range, 31-55 years). The mean follow-up period was 56.5 months (range, 17-112 months). The neurological outcome was evaluated before and after operations (immediately, 6 months after and final follow-up) using grading systems of the walking ability, brachialgia and deltoid power. Results : At immediate postoperative period, after 6 months, and at final follow-up, all patients showed apparent clinical improvements in walking ability, upper extremity pain and deltoid muscle strength. Late neurological deterioration was not seen during follow-up periods. There were no serious complications related to surgery. Conclusion : Surgical decompression and stabilization in patients with cervical spondylotic myelopathy associated with athetoid cerebral palsy have been challenging procedure up to now. Our results indicate that early diagnosis and appropriate surgical procedure can effectively improve the clinical symptoms and neurological function in patients with cervical spondylotic myelopathy and athetoid cerebral palsy, even in those with severe involuntary movements.

Keywords

References

  1. Anderson WW, Wise BL, Itabashi HH, Jones M : Cervical spondylosis in patients with athetosis. Neurology 12 : 410-412, 1962 https://doi.org/10.1212/WNL.12.6.410
  2. Azuma S, Seichi A, Ohnishi I, Kawaguchi H, Kitagawa T, Nakamura K : Long-Term Results of Operative Treatment for Cervical Spondylotic Myelopathy in Patients With Athetoid Cerebral Palsy. An Over 10-Year Follow-Up Study. Spine 27 : 943-948; discussion 948, 2002 https://doi.org/10.1097/00007632-200205010-00011
  3. Basciani M. Intiso D. Cioffi RP. Tonali P : Preoperative treatment with botulinum A toxin in patients with cervical disk herniation secondary to dystonic cerebral palsy. Neurol Sci 21 : 63, 2000 https://doi.org/10.1007/s100720070122
  4. Cho YJ, Lee MH, Chang SK : Cervical Radiographic Study in Adolescence Cerebral Palsy. J Korean Acad Rehabil Med 22 : 543- 551, 1998
  5. Denis F, Armstrong GW, Searls K, Matta L : Acute thoracolumbar burst fractures in the absence of neurologic deficit. A comparison between operative and nonoperative treatment. Clin Orthop Relat Res 189 : 142-149, 1984
  6. Duruflé A, Pétrilli S, Le Guiet JL, Brassier G, Nicolas B, Le Tallec H, et al : Cervical spondylotic myelopathy in athetoid cerebral palsy patients about five cases. Joint Bone Spine 72 : 270-274, 2005 https://doi.org/10.1016/j.jbspin.2004.05.002
  7. Epstein NE : Circumferential cervical surgery for spondylostenosis with kyphosis in two patients with athetoid cerebral palsy. Surg Neurol 52 : 339-344, 1999 https://doi.org/10.1016/S0090-3019(99)00117-2
  8. Fuji T, Yonenobu K, Fujiwara K, Yamashita K, Ebara S, Ono K, et al : Cervical radiculopathy or myelopathy secondary to athetoid cerebral palsy. J Bone Joint Surg Am 69 : 815-821, 1987 https://doi.org/10.2106/00004623-198769060-00004
  9. Haro H, Komori H, Okawa A, Shinomiya K : Surgical treatment of cervical spondylotic myelopathy associated with athetoid cerebral palsy. J Orthop Sci 7 : 629-636, 2002 https://doi.org/10.1007/s007760200113
  10. Henry G. Chambers : Advances in cerebral palsy. Curr Opin Ortho 13 : 424-431, 2002 https://doi.org/10.1097/00001433-200212000-00007
  11. Kidron D, Steiner I, Melamed E : Late-onset progressive radiculomyelopathy in patients with cervical athetoid-dystonic cerebral palsy. Eur Neurol 27 : 164-166, 1987 https://doi.org/10.1159/000116150
  12. Kikkawa J, Shirado O, Saito F, Takahashi K, Oda H : Quadriparesis Due to Intraspinal Cyst After Failed Posterior Occipitocervical Fusion in a Patient With Athetoid Cerebral Palsy. Spine 31: E980-983 , 2006 https://doi.org/10.1097/01.brs.0000248125.30498.f3
  13. Kim JG, Kim SW, Lee SM, Shin H : Surgical Result of the Combined Anterior and Posterior Approach in Treatment of Cervical Spondylotic Myelopathy. J Korean Neurosurg Soc 39 : 188-191, 2006
  14. Kim JS, Ryu KH, Yang SH : Management of Cervical Myelopathy in Athetoid Cerebral Palsy : Case report. J Korean Acad Rehabil Med 22 : 1136-1140. 1998
  15. Ko HY, Park-Ko I : Spinal cord injury secondary to cervical disc herniation in ambulatory patients with cerebral palsy. Spinal Cord 36 : 288-292, 1998 https://doi.org/10.1038/sj.sc.3100607
  16. Levine RA, Rosenbaum AE, Waltz JM, Scheinberg LC : Cervical spondylosis and dyskinesias. Neurology 20 : 1194-1199, 1970 https://doi.org/10.1212/WNL.20.12.1194
  17. McCluer S : Cervical spondylosis with myelopathy as a complication of cerebral palsy. Paraplegia 20 : 308-312, 1982 https://doi.org/10.1038/sc.1982.58
  18. Nishihara N, Tanabe G, Nakahara S, Imai T, Murakawa H : Surgical treatment of cervical spondylotic myelopathy complicating athetoid cerebral palsy. J Bone Joint Surg Br 66 : 504-508 , 1984 https://doi.org/10.2106/00004623-198466040-00003
  19. Onari K, Kondo S, Mihara H, Iwamura Y : Combined anterior and posterior fusion for cervical spondylotic myelopathy in patients with athetoid cerebral palsy. J Neurosurg (1 Suppl) 97 : 13-19, 2002
  20. Onari K : Surgical treatment for cervical spondylotic myelopathy associated with athetoid cerebral palsy. J Orthop Sci 5 : 439-448, 2000 https://doi.org/10.1007/s007760070021
  21. Pollak L, Schiffer J, Klein C, Mirovsky Y, Copeliovich L, Rabey JM : Neurosurgical intervention for cervical disk disease in dystonic cerebral palsy. Mov Disord 13 : 713-717, 1998 https://doi.org/10.1002/mds.870130418
  22. Pollak L. Schiffer J, Klein C, Mirovsky Y, Copeliovich L, Rabey JM : Neurosurgical intervention for cervical disk disease in dystonic cerebral palsy. Mov Disord 13 : 713-717, 1998 https://doi.org/10.1002/mds.870130418
  23. Racette BA. Lauryssen C, Perlmutter JS : Preoperative treatment with botulinum toxin to facilitate cervical fusion in dystonic cerebral palsy. J Neurosurg 88 : 328-330, 1998 https://doi.org/10.3171/jns.1998.88.2.0328
  24. Seichi A, Takeshita K, Ohishi I, Kawaguchi H, Akune T, Anamizu Y, et al : Long-term results of double-door laminoplasty for cervical stenotic myelopathy. Spine 26 : 479-487, 2001 https://doi.org/10.1097/00007632-200103010-00010
  25. Traynelis VC, Ryken T, Rodnitzky RL, Menezes AH : Botulinum toxin enhancement of postoperative immobilization in patients with cervical dystonia. Technical note. J Neurosurg 77 : 808-809, 1992 https://doi.org/10.3171/jns.1992.77.5.0808
  26. Tsirikos AI, Chang WN, Shah SA, Miller F : Acquired Atlantoaxial Instability in Children With Spastic Cerebral Palsy. J Pediatr Orthop 23 : 335-341 , 2003 https://doi.org/10.1097/00004694-200305000-00011
  27. Ueda Y, Yoshikawa T, Koizumi M, Iida J, Miyazaki K, Nishiyama S, et al : Cervical Laminoplasty Combined With Muscle Release in Patients With Athetoid Cerebral Palsy. Spine 30 : 2420-2423, 2005 https://doi.org/10.1097/01.brs.0000184691.49314.41
  28. Wong AS, Massicotte EM, Fehlings MG : Surgical Treatment of Cervical Myeloradiculopathy Associated with Movement Disorders ; Indications, Technique, and Clinical Outcome. J Spinal Disord Tech 18 : S107-S114 , 2005 https://doi.org/10.1097/01.bsd.0000128693.44276.86