Treatment Strategy for Cervical Myelopathy in Patients with Athetoid Cerebral Palsy

Abstract

Aim: In athetoid cerebral palsy (ACP) patients, severe and progressive cervical myelopathy (CM) often develops at a young age for the reason that involuntary movement due to ACP facilitates degeneration of cervical spine. The purpose of this retrospective study was to explore the optimal management of CM due to ACP. Materials and Methods: From 2004 through 2013, 16 consecutive cases of CM in ACP who were surgically treated were studied. They included 7 males and 9 females with a mean age of 55 years. Mean duration of postoperative follow-up was 3 years and 6 months. We clinically and radiographically evaluated in these cases. Results: Posterior decompression and fusion was employed in 10 cases, posterior fusion in 4 cases, and laminoplasty in 2 cases. In 13 cases, botulinum toxin injection, selective muscle release, or both were additionally performed. As to clinical outcome evaluated by Fuji’s scale, 4 cases had excellent, 8 cases had good, 3 cases had fair, and 1 case had poor results. Perioperative complication was observed in 8 cases. Lordosis of cervical spine increased in 6 cases, decreased in 4 cases, and unchanged in 6 cases after surgery. Bone union was obtained in all 14 cases who were performed fusion surgery. Conclusions: For the treatment of CM in ACP, evaluations of the intensity and the pattern of athetoid movement are important features for selection of the proper surgical method. Strong cervical fixation accompanied with various athetoid movement control procedures to achieve solid bone union may warrant long-term acceptable clinical results.