title: Long-term surgical outcomes of cervical myelopathy with athetoid cerebral palsy.
abstract: OBJECTIVE
  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.
authors: 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.
authors: Keung Nyun
authors: KN
authors: Kim
authors: Poong Gee
authors: PG
authors: Ahn
authors: Mi Jung
authors: MJ
authors: Ryu
authors: Dong Ah
authors: DA
authors: Shin
authors: Seong
authors: S
authors: Yi
authors: Do Heum
authors: DH
authors: Yoon
authors: Yoon
authors: Y
authors: Ha
mesh_terms: D000328:Adult; D000368:Aged; D001268:Atlanto-Axial Joint / Q000601:surgery; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use; D002547:Cerebral Palsy / Q000150:complications*; D002574:Cervical Vertebrae / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000209:etiology / Q000601:surgery*; D007738:Kyphosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000627:therapeutic use; D063868:Patient Outcome Assessment; D011183:Postoperative Complications; D011379:Prognosis; D012086:Reoperation; D012189:Retrospective Studies; D013117:Spinal Cord Compression / Q000209:etiology / Q000601:surgery*; D013123:Spinal Fusion; D064232:Visual Analog Scale; D055815:Young Adult
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A