title: Cervical myelopathy in patients with athetoid cerebral palsy.
abstract: METHODS
  Retrospective clinical study.
  
  
  OBJECTIVE
  To report the surgical outcomes of patients with cervical myelopathy associated with athetoid cerebral palsy and to assess whether a halo vest is necessary for postoperative external immobilization.
  
  
  BACKGROUND
  Although a halo vest has remained the first choice for postoperative external immobilization of patients with cervical myelopathy associated with cerebral palsy, simplification of this method has been attempted in recent years. Studies focusing on postoperative external immobilization are rare.
  
  
  METHODS
  Since 2001, 20 patients underwent surgery with posterior instrumented fusion or posterior fixation and anterior decompression with fusion with a year or longer follow-up. Before 2004, all patients were given a halo vest for postoperative external immobilization. After 2004, halo vests were not used, and when abnormal involuntary neck movements were severe, an intramuscular injection of botulinum toxin was administered before and after surgery. Surgical outcomes, surgical methods and complications were compared between the group that used a halo vest and the group that did not use a halo vest.
  
  
  RESULTS
  In the halo vest group, the average Japanese Orthopedic Association score was 6.9 points before surgery and 9.3 points at 1-year follow-up. The average recovery rate was 25.0%. In the group without halo vest use, the average Japanese Orthopedic Association score was 5.8 points before surgery and 9.9 points at 1-year follow-up. The average recovery rate was 35.7%. The group without halo vest use achieved outcomes equal to those achieved in the group with halo vest use. The frequency of complications was less without halo vest use than with halo vest use.
  
  
  CONCLUSIONS
  No inferiority in clinical outcomes was seen if postoperative halo vest use was omitted. Progress in surgical instrumentation and injection of botulinum toxin may explain this result.
authors.affiliation: Spine Division, Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan. takeo1225@snow.plala.or.jp
authors.forename: Takeo
authors.initials: T
authors.lastname: Furuya
authors.forename: Masashi
authors.initials: M
authors.lastname: Yamazaki
authors.forename: Akihiko
authors.initials: A
authors.lastname: Okawa
authors.forename: Sonoko
authors.initials: S
authors.lastname: Misawa
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Sakuma
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Takahashi
authors.forename: Kei
authors.initials: K
authors.lastname: Kato
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kuwabara
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Takahashi
mesh_terms: D000328:Adult; D000368:Aged; D001905:Botulinum Toxins / Q000008:administration & dosage; D002547:Cerebral Palsy / Q000150:complications*; D002574:Cervical Vertebrae / Q000601:surgery; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D006801:Humans; D007103:Immobilization / Q000295:instrumentation; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D009989:Orthotic Devices / Q000009:adverse effects; D017063:Outcome Assessment, Health Care; D011182:Postoperative Care / Q000379:methods; D012189:Retrospective Studies; D013118:Spinal Cord Diseases / Q000150:complications / Q000601:surgery* / Q000628:therapy; D013123:Spinal Fusion / Q000379:methods*; D013997:Time Factors
chemical_list: D001905:Botulinum Toxins