Surgical treatment of cervical myeloradiculopathy associated with movement disorders: indications, technique, and clinical outcome.
OBJECTIVE
Movement disorders may be associated with advanced cervical myeloradiculopathy, which represents a major management challenge. We report on eight patients with movement disorders causing progressive cervical myeloradiculopathy who were treated successfully by cervical decompression and reconstruction.


RESULTS
The mean age of our patients was 44 years with a male/female ratio of 3:1. The average duration of symptoms prior to presentation was 10 months. The most common levels decompressed and reconstructed were C3-C4 and C4-C5. Six cases showed improvement, and two cases showed stabilization of neurologic status at a mean follow-up of 21 months. Our management strategy and results are interpreted in the context of a systematic review of the literature in which 78 cases are reported.


CONCLUSIONS
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.
Wong
Albert S
AS
Division of Neurosurgery, University of Toronto, and Spinal Program, Krembil Neuroscience Center, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
Massicotte
Eric M
EM
Fehlings
Michael G
MG
D000328:Adult; D001264:Athetosis / Q000150:complications; D001905:Botulinum Toxins / Q000627:therapeutic use; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D019299:Decompression, Surgical / Q000295:instrumentation / Q000379:methods* / Q000706:statistics & numerical data; D016267:External Fixators / Q000592:standards; D005260:Female; D006801:Humans; D016268:Internal Fixators / Q000592:standards; D007738:Kyphosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009069:Movement Disorders / Q000150:complications*; D011300:Preoperative Care / Q000592:standards; D011843:Radiculopathy / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000295:instrumentation / Q000379:methods* / Q000706:statistics & numerical data; D013117:Spinal Cord Compression / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods; D013128:Spinal Osteophytosis / Q000150:complications* / Q000503:physiopathology / Q000601:surgery*; D014103:Torticollis / Q000150:complications; D005879:Tourette Syndrome / Q000150:complications
D001905:Botulinum Toxins