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Long-term surgical outcomes of cervical myelopathy with athetoid cerebral palsy

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Abstract

Purpose

To understand the long-term surgical outcomes and prognostic factors for the operative treatment of cervical myelopathy (CM) in patients with athetoid cerebral palsy (ACP).

Methods

We retrospectively reviewed 24 patients with ACP who underwent surgery for CM at our hospital between March 2002 and June 2008. All patients had more than 5 years follow-up. Anterior fusion (11 patients), posterior fusion (1 patient), or combined anterior and posterior (AP) fusion (7 patients) and C1-2 fusion (5 patients) surgeries were performed. Surgical outcomes (average follow-up 102 months), as assessed using modified JOA (mJOA) scores, the Neck Disability Index (NDI), and a visual analog scale (VAS) were compared between the preoperative and postoperative states.

Results

Preoperatvie cervical kyphosis decreased mJOA scores significantly. Long-term follow-up clinical outcomes demonstrated that 10 patients showed favorable (excellent and good) outcomes and 11 patients had non-favorable (fair and worse) outcomes. According to the mJOA scores, patients showed postoperative improvement (7.10–10.45). NDI decreased from 68.46 to 31.66. A second operation was done in seven cases due to instrument failure, progressive kyphotic deformities and adjacent segment degeneration. A preoperative botulinum toxin injection significantly decreased (p < 0.05) the incidence of a second operation.

Conclusions

Patients with ACP have high incidence of instrument failure. Strong surgical fixation, bone fusion and perioperative immobilizations using botulinum toxin injection should be carefully planned preoperatively.

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Acknowledgments

This research was supported by the faculty research grant of Yonsei University College of Medicine for 2011.

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Authors and Affiliations

  1. Department of Neurosurgery, Spine and Spinal Cord Research Institute, College of Medicine, Yonsei University College of Medicine, 134 Shinchon-dong, Seodaemun-gu, Seoul, 120-752, Korea

    Keung Nyun Kim, Poong Gee Ahn, Mi Jung Ryu, Dong Ah Shin, Seong Yi, Do Heum Yoon & Yoon Ha

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  1. Keung Nyun Kim
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  2. Poong Gee Ahn
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Correspondence to Yoon Ha.

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Kim, K.N., Ahn, P.G., Ryu, M.J. 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

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  • DOI: https://doi.org/10.1007/s00586-013-3119-4

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