Long-term results of operative treatment for cervical spondylotic myelopathy in patients with athetoid cerebral palsy: an over 10-year follow-up study.
Spine, 27 (9):
943--8; discussion 948 (May 2002)Abstract
STUDY DESIGN: A retrospective radiographic and medical record analysis of patients followed for more than 10 years after operative treatment for cervical spondylotic myelopathy complicating athetoid cerebral palsy. OBJECTIVE: To describe the incidence of late neurologic deterioration and spinal deformity after operative treatment for cervical spondylotic myelopathy in athetoid cerebral palsy. SUMMARY OF BACKGROUND DATA: The possibility of recurrence of symptoms after operative treatment for cervical spondylotic myelopathy seems greater in patients with athetoid cerebral palsy because of their involuntary neck movements. Although there are several reports of surgical results, long-term follow-up studies are very rare. METHODS: Ten patients with athetoid cerebral palsy were evaluated over an average of 15 years after anterior decompression (corpectomy) and fusion (three patients), laminectomy (one patient), and laminoplasty (six patients, four with accompanying posterior fusion). They averaged 45 years of age at surgery. Surgical results were assessed using Kurokawa's method. Late neurologic deterioration was based on decrement in the JOA score, and the evolution of kyphosis or instability of the cervical spine was observed radiographically. RESULTS: Surgical results at the most improved period were good or excellent in all 10 patients. Eight showed late neurologic deterioration, however, and six of them deteriorated from 8 to 13 years after surgery, largely because of progressive deformity. CONCLUSIONS: Long-term follow-up evaluation is essential in any type of operation, particularly with patients with athetoid cerebral palsy who often undergo this operation in their 30s or 40s.