More Than 10-year Follow-up After Laminoplasty and Pedicle Screw Fixation for Cervical Myelopathy Associated With Athetoid Cerebral Palsy

Abstract

Study Design. Retrospective case series. Objective. The aim of this study was to investigate the clinical outcomes >10 years following laminoplasty and pedicle screw fixation for cervical myelopathy associated with athetoid cerebral palsy (CP). Summary of Background Data. Surgery for cervical myelopathy associated with CP remains a challenge because of perioperative instrumentation failure and adjacent segment problems due to patients’ repetitive involuntary neck movements with deformity of the cervical spine. Methods. A single-center series of 14 patients were reviewed. The patients comprised seven women and seven men with a mean age of 52 years at the time of surgery. The mean follow-up period was 12.5 years. The Barthel index (BI), which shows independence in activities of daily life, and Japanese Orthopaedic Association (JOA) score were assessed. Radiographic evaluation included changes of the C2–C7 angle in the sagittal plane, fusion rate, adjacent segment degeneration, and instrument failure. Results. The 10-year BI and JOA score significantly improved at 36% and 31%, respectively. The preoperative Cobb angle of the sagittal plane from C2–C7 measured 11.9° of kyphosis, which improved to 0.8° of lordosis. In the radiographic analysis, 35% (proximal) and 21% (distal) of the adjacent segment showed progression in degeneration of more than one grade after 10 years. More than 90% of the patients who underwent magnetic resonance imaging showed progressive disc degeneration on either side after 10 years. Autofusion inside the disc or anterior vertebral bony bridging was observed in 86% of intervertebral levels without anterior procedures. Conclusion. The procedure showed favorable initial stability and maintained favorable clinical outcomes in patients with CP. More than 90% of the patients showed disc degeneration on either side. The rate of proximal adjacent segment degeneration was higher than that of distal segments with or without symptoms at the >10-year follow-up. Level of Evidence: 4

Surgical outcomes of cervical myelopathy in patients with athetoid cerebral palsy

“…To evaluate the clinical functions for patients with cervical myelopathy associated with athetoid CP, it might be difficult to use the JOA score system because it assesses the neurological function of these patients [17]. In the current study, we used the BI to evaluate the ADL of patients with CP [7,12]. The JOA scores of overall patients were not significantly improved; however, the BI improved significantly after surgery.…”

“…For the surgical strategy, spinal instrumented fusion is generally recommended for cervical myelopathy associated with athetoid CP due to the involuntary neck movements and cervical instability [5][6][7][8]. Regarding complications related to fusion surgery, it has been reported that more than 90% of the patients show disc degeneration of the adjacent segment of the fusion site and some patients have to undergo additional fusion surgery, and 23% of patients show adjacent diseases with recurrent myelopathy after previous fusion surgery with a mean interval of 8 years [7,8].…”

“…For the surgical strategy, spinal instrumented fusion is generally recommended for cervical myelopathy associated with athetoid CP due to the involuntary neck movements and cervical instability [5][6][7][8]. Regarding complications related to fusion surgery, it has been reported that more than 90% of the patients show disc degeneration of the adjacent segment of the fusion site and some patients have to undergo additional fusion surgery, and 23% of patients show adjacent diseases with recurrent myelopathy after previous fusion surgery with a mean interval of 8 years [7,8]. Azuma et al reported that surgical outcomes were satisfactory with any type of surgery including posterior decompression with or without fusion at the most improved period; however, most patients showed late neurological deterioration in patients with or without fusion because of progressive deformity [9].…”

“…In patients with cervical myelopathy associated with athetoid CP, once the symptoms of spinal cord dysfunction develop, muscle tone and involuntary movements due to CP often synergise with the progression of cervical cord symptoms, resulting in decrease in activity and depression in daily life. Some researchers have reported favourable results of the surgical treatment of cervical myelopathy associated with athetoid CP [5][6][7][8]. Generally, fusion surgery is recommended for cervical myelopathy associated with athetoid CP, because most patients show late neurological deterioration and progressive deformity after decompression surgery such as laminectomy [2,9].…”

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

“…Apart from the incidence of complications, the clinical outcome is another important factor used to assess the postoperative prognosis. Demura et al [ 3 ] showed that the 10-year Barthel index and JOA score after cervical surgery significantly improved (by 36% and 31%, respectively) in 14 patients with CSM and CP. Additionally, Watanabe et al [ 29 ] reported that the JOA score improved from 8.3 points preoperatively to 10.9 points by the final follow-up (mean, 58 months) in patients with cervical disorder-associated CP who underwent posterior fusion using cervical pedicle screws; however, one-third of the patients were unable to walk at the final follow-up owing to myelopathy progression.…”