Combined anterior-posterior fusion for cervical spondylotic myelopathy in patients with athetoid cerebral palsy.
OBJECTIVE
Cervical spondylotic myelopathy (CSM) or myeloradiculopathy, frequent in adults with athetoid cerebral palsy, is a serious secondary disability in patients with an existing congenital handicap. Although several surgical procedures have been described for CSM in adults with athetoid cerebral palsy, none has had satisfying long-term results. The object of this study was to evaluate the effectiveness and safety of combined anterior-posterior fusion with wave-shaped rods and its influence on the stability of other spinal segments.


METHODS
Twenty-three patients with CSM and athetoid cerebral palsy underwent posterior fusion with wave-shaped rods combined with anterior interbody fusion with internal fixation; 20 patients, 17 men and three women, were followed for more than 5 years. This procedure yielded good results. The mean follow-up period was 8.7 years (range 5-17 years). At 1-year follow-up examination, ambulation had improved in 12 patients. Upper-extremity pain, deltoid muscle weakness, and ability to self-feed improved in almost all patients. Myelopathy recurred in one patient 8.5 years after surgery. The mean motion angle at the adjacent level to the fixed segment did not change postoperatively, but the mean motion between C-1 and C-2 increased and slight atlantoaxial subluxation occurred postoperatively in five patients.


CONCLUSIONS
Combined anterior-posterior fusion can effectively improve neurological function in patients with CSM and athetoid cerebral palsy, even in those with severe involuntary movements. Postoperative rigid external fixation is not required.
Department of Orthopedic Surgery, Yokohama Minami Kyosai Hospital, Kanagawa, Japan. ykonari@aol.com
Katsuhiro
K
Onari
Soichi
S
Kondo
Hisanori
H
Mihara
Yuichi
Y
Iwamura
D000328:Adult; D000368:Aged; D002547:Cerebral Palsy / Q000150:complications*; D002574:Cervical Vertebrae / Q000601:surgery*; D004435:Eating; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000503:physiopathology; D009985:Orthopedics / Q000379:methods; D010146:Pain / Q000503:physiopathology; D010166:Palliative Care; D011183:Postoperative Complications; D011184:Postoperative Period; D011859:Radiography; D012008:Recurrence; D013117:Spinal Cord Compression / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery*; D013123:Spinal Fusion; D013128:Spinal Osteophytosis / Q000150:complications* / Q000000981:diagnostic imaging; D016138:Walking