Journal of Korean Neurosurgical Society

  • 제64권5호
  • /
  • Pages.808-817
  • /
  • 2021
  • /
  • 2005-3711(pISSN)
  • /
  • 1598-7876(eISSN)
대한신경외과학회 (The Korean Neurosurgical Society)
권호 표지
DOI QR코드

DOI QR Code

Factors Affecting Postoperative Complications and Outcomes of Cervical Spondylotic Myelopathy with Cerebral Palsy : A Retrospective Analysis

  • Kim, Hyung Cheol (Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine) ;
  • Jeon, Hyeongseok (Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine) ;
  • Jeong, Yeong Ha (Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine) ;
  • Park, Sangman (Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine) ;
  • An, Seong Bae (Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine) ;
  • Heo, Jeong Hyun (Department and Research Institute of Rehabilitation Medicine, Severance Hospital, Yonsei University College of Medicine) ;
  • Shin, Dong Ah (Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine) ;
  • Yi, Seong (Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine) ;
  • Kim, Keung Nyun (Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine) ;
  • Ha, Yoon (Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine) ;
  • Cho, Sung-Rae (Department and Research Institute of Rehabilitation Medicine, Severance Hospital, Yonsei University College of Medicine)
  • 투고 : 2021.01.13
  • 심사 : 2021.03.10
  • 발행 : 2021.09.01
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Objective : Cervical surgery in patients with cervical spondylotic myelopathy (CSM) and cerebral palsy (CP) is challenging owing to the complexities of the deformity. We assessed factors affecting postoperative complications and outcomes after CSM surgery in patients with CP. Methods : Thirty-five consecutive patients with CP and CSM who underwent cervical operations between January 2006 and January 2014 were matched to 35 non-cerebral palsy (NCP) control patients. Postoperative complications and radiologic outcomes were compared between the groups. In the CP group, the Japanese Orthopaedic Association score; Oswestry neck disability index; modified Barthel index; and values for the grip and pinch, Box and Block, and Jebsen-Taylor hand function tests were obtained pre- and postoperatively and compared between those with and without postoperative complications. Results : Sixteen patients (16/35%) in the CP group and seven (7/35%) in the NCP group (p=0.021) had postoperative complications. Adjacent segment degeneration (p=0.021), postoperative motor weakness (p=0.037), and revisions (p=0.003) were significantly more frequent in the CP group than in the NCP group; however, instrument-related complications were not significantly higher in the CP group (7/35 vs. 5/35, p=0.280). The number of preoperative fixed cervical deformities were significantly higher in CP with postoperative complications (5/16 vs. 1/19, p=0.037). In the CP group, clinical outcomes were almost similar between those with and without postoperative complications. Conclusion : The occurrence of complications during the follow-up period was high in patients with CP. However, postoperative complications did not significantly affect clinical outcomes.

키워드

과제정보

This research was supported by a grant of the Developing Regional Innovation Clusters R&D Project through the Korea Institute for Advancement of Technology (KIAT), funded by Ministry of Trade, Industry and Energy, Republic of Korea (grant number : P0015342).

참고문헌

  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 (Phila Pa 1976) 27 : 943-948; discussion 948, 2002 https://doi.org/10.1097/00007632-200205010-00011
  3. Demura S, Kato S, Shinmura K, Yokogawa N, Yonezawa N, Shimizu T, et al. : More than 10-year follow-up after laminoplasty and pedicle screw fixation for cervical myelopathy associated with athetoid cerebral palsy. Spine (Phila Pa 1976) 45 : 727-734, 2020 https://doi.org/10.1097/BRS.0000000000003383
  4. Demura S, Murakami H, Kawahara N, Kato S, Yoshioka K, Tsuchiya H : Laminoplasty and pedicle screw fixation for cervical myelopathy associated with athetoid cerebral palsy: minimum 5-year follow-up. Spine (Phila Pa 1976) 38 : 1764-1769, 2013 https://doi.org/10.1097/BRS.0b013e31829eca52
  5. 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
  6. Harada T, Ebara S, Anwar MM, Okawa A, Kajiura I, Hiroshima K : The cervical spine in athetoid cerebral palsy. A radiological study of 180 patients. J Bone Joint Surg Br 78 : 613-619, 1996
  7. Hartmann S, Thome C, Abramovic A, Lener S, Schmoelz W, Koller J, et al. : The effect of rod pattern, outrigger, and multiple screw-rod constructs for surgical stabilization of the 3-column destabilized cervical spine - a biomechanical analysis and introduction of a novel technique. Neurospine 17 : 610-629, 2020 https://doi.org/10.14245/ns.2040436.218
  8. Hasler CC : Operative treatment for spinal deformities in cerebral palsy. J Child Orthop 7 : 419-423, 2013 https://doi.org/10.1007/s11832-013-0517-4
  9. Jameson R, Rech C, Garreau de Loubresse C : Cervical myelopathy in athetoid and dystonic cerebral palsy: retrospective study and literature review. Eur Spine J 19 : 706-712, 2010 https://doi.org/10.1007/s00586-009-1271-7
  10. 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
  11. Kim CW, Hyun SJ, Kim KJ : Surgical impact on global sagittal alignment and health-related quality of life following cervical kyphosis correction surgery: systematic review. Neurospine 17 : 497-504, 2020 https://doi.org/10.14245/ns.2040476.238
  12. Kim KN, Ahn PG, Ryu MJ, Shin DA, Yi S, Yoon DH, et al. : Long-term surgical outcomes of cervical myelopathy with athetoid cerebral palsy. Eur Spine J 23 : 1464-1471, 2014 https://doi.org/10.1007/s00586-013-3119-4
  13. Lau D, Ames CP : Three-column osteotomy for the treatment of rigid cervical deformity. Neurospine 17 : 525-533, 2020 https://doi.org/10.14245/ns.2040466.233
  14. Lee CK, Shin DA, Yi S, Kim KN, Shin HC, Yoon DH, et al. : Correlation between cervical spine sagittal alignment and clinical outcome after cervical laminoplasty for ossification of the posterior longitudinal ligament. J Neurosurg Spine 24 : 100-107, 2016 https://doi.org/10.3171/2015.4.SPINE141004
  15. Lee JJ, Oh SH, Jeong YH, Park SM, Jeon HS, Kim HC, et al. : Surgical strategies for cervical deformities associated with neuromuscular disorders. Neurospine 17 : 513-524, 2020 https://doi.org/10.14245/ns.2040464.232
  16. Lee YJ, Chung DS, Kim JT, Bong HJ, Han YM, Park YS : Surgical treatments for cervical spondylotic myelopathy associated with athetoid cerebral palsy. J Korean Neurosurg Soc 43 : 294-299, 2008 https://doi.org/10.3340/jkns.2008.43.6.294
  17. Master DL, Son-Hing JP, Poe-Kochert C, Armstrong DG, Thompson GH : Risk factors for major complications after surgery for neuromuscular scoliosis. Spine (Phila Pa 1976) 36 : 564-571, 2011 https://doi.org/10.1097/BRS.0b013e3181e193e9
  18. McCluer S : Cervical spondylosis with myelopathy as a complication of cerebral palsy. Paraplegia 20 : 308-312, 1982
  19. 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
  20. Piazzolla A, Solarino G, De Giorgi S, Mori CM, Moretti L, De Giorgi G : Cotrel-Dubousset instrumentation in neuromuscular scoliosis. Eur Spine J 20 Suppl 1 : S75-S84, 2011
  21. Polk JL, Maragos VA, Nicholas JJ : Cervical spondylotic myeloradiculopathy in dystonia. Arch Phys Med Rehabil 73 : 389-392, 1992 https://doi.org/10.1016/0003-9993(92)90016-P
  22. Pollard CA : Preliminary validity study of the pain disability index. Percept Mot Skills 59 : 974, 1984 https://doi.org/10.2466/pms.1984.59.3.974
  23. Rumalla K, Yarbrough CK, Pugely AJ, Koester L, Dorward IG : Spinal fusion for pediatric neuromuscular scoliosis: national trends, complications, and in-hospital outcomes. J Neurosurg Spine 25 : 500-508, 2016 https://doi.org/10.3171/2016.2.SPINE151377
  24. Samdani AF, Belin EJ, Bennett JT, Miyanji F, Pahys JM, Shah SA, et al. : Major perioperative complications after spine surgery in patients with cerebral palsy: assessment of risk factors. Eur Spine J 25 : 795-800, 2016 https://doi.org/10.1007/s00586-015-4054-3
  25. Scheer JK, Tang JA, Smith JS, Acosta FL Jr, Protopsaltis TS, Blondel B, et al. : Cervical spine alignment, sagittal deformity, and clinical implications: a review. J Neurosurg Spine 19 : 141-159, 2013 https://doi.org/10.3171/2013.4.SPINE12838
  26. Sharma S, Wu C, Andersen T, Wang Y, Hansen ES, Bunger CE : Prevalence of complications in neuromuscular scoliosis surgery: a literature meta-analysis from the past 15 years. Eur Spine J 22 : 1230-1249, 2013 https://doi.org/10.1007/s00586-012-2542-2
  27. Shimokawa N, Sato H, Matsumoto H, Takami T : Complex revision surgery for cervical deformity or implant failure. Neurospine 17 : 543-553, 2020 https://doi.org/10.14245/ns.2040410.205
  28. Vialle R, Thevenin-Lemoine C, Mary P : Neuromuscular scoliosis. Orthop Traumatol Surg Res 99 : S124-S139, 2013 https://doi.org/10.1016/j.otsr.2012.11.002
  29. Watanabe K, Hirano T, Katsumi K, Ohashi M, Shoji H, Yamazaki A, et al. : Surgical outcomes of posterior spinal fusion alone using cervical pedicle screw constructs for cervical disorders associated with athetoid cerebral palsy. Spine (Phila Pa 1976) 42 : 1835-1843, 2017 https://doi.org/10.1097/BRS.0000000000002257
  30. Watanabe K, Otani K, Nikaido T, Kato K, Kobayashi H, Yabuki S, et al. : Surgical outcomes of cervical myelopathy in patients with athetoid cerebral palsy: a 5-year follow-up. Asian Spine J11 : 928-934, 2017
  31. Wewel JT, Brahimaj BC, Kasliwal MK, Traynelis VC : Perioperative complications with multilevel anterior and posterior cervical decompression and fusion. J Neurosurg Spine 20 : 1-6, 2019 https://doi.org/10.3171/2013.9.SPINE12952
  32. 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 Suppl : S107-S114, 2005 https://doi.org/10.1097/01.bsd.0000128693.44276.86
  33. Yaszay B, Bartley CE, Sponseller PD, Abel M, Cahill PJ, Shah SA, et al. : Major complications following surgical correction of spine deformity in 257 patients with cerebral palsy. Spine Deform 8 : 1305-1312, 2020 https://doi.org/10.1007/s43390-020-00165-7
  34. Yonenobu K, Okada K, Fuji T, Fujiwara K, Yamashita K, Ono K : Causes of neurologic deterioration following surgical treatment of cervical myelopathy. Spine (Phila Pa 1976) 11 : 818-823, 1986 https://doi.org/10.1097/00007632-198610000-00016