Late-Onset Progressive Radiculomyelopathy in Patients with Cervical Athetoid-Dystonic Cerebral Palsy

Kidron, Daphne; Steiner, Israel; Melamed, Eldad

doi:10.1159/000116150

Cited by 28 publications

(16 citation statements)

References 8 publications

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“…Laminectomy for decompression of the cervical spinal cord and the foramina -introduced in the early 1970s -was the fi rst technique which was routinely used in patients with dystonic movement disorders [16,20,21,43] . In early series, postoperative results were only rarely satisfactory.…”

Section: Posterior Approachmentioning

confidence: 99%

Dystonic Movement Disorders and Spinal Degenerative Disease

Loher

Bärlocher²,

Krauss³

2006

Stereotact Funct Neurosurg

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The occurrence of degenerative spinal disease subsequent to dystonic movement disorders has been neglected and has received more attention only recently. Spinal surgery is challenging with regard to continuous mechanical stress when treatment of the underlying movement disorder is insufficient. To characterize better the particular features of degenerative spinal disease in patients with dystonia and to analyze operative strategies, we reviewed the available published data. Epidemiologic studies reveal that degenerative spinal disorders in patients with dystonia and choreoathetosis occur much earlier than in the physiological aging process. Dystonic movement disorders more often affect the spine at higher cervical levels (C_2–5), in contrast to spinal degeneration with age which manifests more frequently at the middle and lower cervical spine (C_5–7). Degenerative changes of the cervical spine are more likely to occur on the side where the chin is rotated or tilted to. Various operative approaches for treatment of spinal pathologies have been advocated in patients with dystonic movement disorders. The available data do not allow making firm statements regarding the superiority of one approach over the other. Posterior approaches were first used for decompression, but additional anterior fusion became necessary in many instances. Anterior approaches with or without instrumented fusion yielded more favorable results, but drawbacks are pseudarthrosis and adjacent-level disease. Parallel to the development of posterior fusion techniques, circumferential surgery was suggested to provide a maximum degree of cord decompression and a higher fusion rate. Perioperative local injections of botulinum toxin were used initially to enhance patient comfort with halo immobilization, but they are also applied in patients without external fixation nowadays. Treatment algorithms directed at the underlying movement disorder itself, taking advantage of new techniques of functional neurosurgery, combined with spinal surgery have recently been introduced and show promising results.

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Section: Posterior Approachmentioning

confidence: 99%

Dystonic Movement Disorders and Spinal Degenerative Disease

Loher

Bärlocher²,

Krauss³

2006

Stereotact Funct Neurosurg

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“…Early cases were treated by laminectomy alone. 4,5,7,15 In the 1980s, other reports showed favorable results from anterior decompression and fusion. [16][17][18] Still others have reported on the use of both anterior and posterior decompressions.…”

Section: Management Strategiesmentioning

confidence: 99%

Surgical Treatment of Cervical Myeloradiculopathy Associated with Movement Disorders

Wong

Massicotte

Fehlings

2005

Journal of Spinal Disorders & Techniques

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Movement disorders cause premature cervical spondylosis most commonly involving the C3-C4 and C4-C5 levels. Ventral pathology with kyphotic angulation requires corpectomy or discectomy with or without posterior decompression and reconstruction. Decompression should always be combined with segmental internal fixation. Perioperative use of botulinum toxin and halo vest immobilization can increase the rate of clinical success but requires vigilance to minimize complications. Laminectomy with lateral mass fixation may be used successfully in the absence of kyphotic deformity.

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“…Early onset of degeneration of the cervical spine and instability due to sustained abnormal tonicity or abnormal movement of the neck are found in patients with cerebral palsy 10,11) . Dystonic athetoid neck movements may cause excessive axial neck rotation as well as flexion and .…”

Section: Discussionmentioning

confidence: 99%

“…As well as the adequate decompression of the compressed neural elements (cord and/or roots), stabilization of the cervical spine and correction of the malalignment are the most important surgery-related goals in cases of this disease, and therefore extremely rigid fixation should be required 19,28) . Clinically, there are many characteristic features in patients with athetoid cerebral palsy compared with other patients without this disease 11) . Onset of the clinical symptoms and signs of the myelopathy are usually seen in the earlier ages than other patients 2,19,20,28) .…”

Section: Discussionmentioning

confidence: 99%

“…Early onset of degeneration of the cervical spine, deformity and instability due to sustained abnormal muscular tonicity or excessive movement of the neck are found in patients with athetoid type of cerebral palsy 10,11) . Cervical spondylotic myelopathy, associated cerebral palsy, is a serious secondary disability for the people who already have this congenital handicap 19) .…”

Section: Introductionmentioning

confidence: 99%

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