Laminoplasty with lateral mass screw fixation for cervical spondylotic myelopathy in patients with athetoid cerebral palsy: A retrospective study

Reoperation Rates According to Surgical Approach After Operation for Degenerative Cervical Pathology in Patients With Athetoid Cerebral Palsy: A Nationwide Cohort Study

STUDY DESIGN

National population-based cohort study.

OBJECTIVE

The overall complication rate for patients with athetoid cerebral palsy (CP) undergoing cervical surgery is significantly higher than that of patients without CP. The study was conducted to compare the reoperation and complication rates of anterior fusion, posterior fusion, combined fusion, and laminoplasty for degenerative cervical myelopathy/radiculopathy in patients with athetoid cerebral palsy.

METHODS

The Korean Health Insurance Review and Assessment Service national database was used for analysis. Data from patients diagnosed with athetoid CP who underwent cervical spine operations for degenerative causes between 2002 and 2020 were reviewed. Patients were categorized into four groups for comparison: anterior fusion, posterior fusion, combined fusion, and laminoplasty.

RESULTS

A total of 672 patients were included in the study. The overall revision rate was 21.0% (141/672). The revision rate was highest in the anterior fusion group (42.7%). The revision rates of combined fusion (11.1%; hazard ratio [HR], .335; P = .002), posterior fusion (13.8%; HR, .533; P = .030) were significantly lower than that of anterior fusion. Revision rate of laminoplasty (13.1%; HR, .541; P = .240) was also lower than anterior fusion although the result did not demonstrate statistical significance.

CONCLUSION

Anterior fusion presented the highest reoperation risk after cervical spine surgery reaching 42.7% in patients with athetoid CP. Therefore, anterior-only fusion in patients with athetoid CP should be avoided or reserved for strictly selected patients. Combined fusion, with the lowest revision risk at 11.1%, could be safely applied to patients with athetoid CP.

Two Cases of Degenerative Cervical Spondylotic Myelopathy in Adults with Athetoid and Dystonic Cerebral Palsy

BACKGROUND Patients with athetoid and dystonic cerebral palsy (ADCP) may develop degenerative changes in the cervical spine that can aggravate their neurological symptoms in adulthood. This report is of 2 cases of ADCP associated with degenerative cervical spondylotic myelopathy in a 39-year-old woman and a 52-year-old man, requiring different surgical treatments. CASE REPORT Case 1. The patient was a 39-year-old woman who had fallen down 7 years before surgery and had since been walking with a cane. Her gait disturbance had worsened in the 2 years prior to surgery, and numbness in her upper limbs appeared. In the year before surgery, spasticity and numbness in the lower limbs worsened, and fine motor impairment also appeared. Because of mild involuntary movements of the neck, cervical laminoplasty from C3 to C6 was performed, and her symptoms remained stable until the last follow-up 4.5 years after surgery. Case 2. The patient was a 52-year-old man who had fallen down 7 years before surgery, resulting in transient limb weakness. In the year before surgery, he had developed fine motor impairment. He subsequently developed gait disturbance and requested cervical surgery. Because of involuntary movements involving the neck and trunk, he underwent cervical posterior fusion from C2 to T1. Six months after surgery, the gait disturbance had improved. CONCLUSIONS This report describes 2 adults with a history of ADCP since birth and highlights that degenerative changes of the cervical spine can occur at a relatively early age in adulthood, requiring an individualized approach to management.

Combined Anterior-Posterior Fusion Versus Posterior Alone Fusion for Cervical Myelopathy in Athetoid-Cerebral Palsy

STUDY DESIGN

Retrospective comparative study.

OBJECTIVES

Although some studies have discussed the use of lateral mass screws (LMSs) in patients with cerebral palsy (CP), it is unclear whether posterior LMS fixation alone is a suitable method. We aimed to compare the clinical, radiological, and surgical outcomes of 2 surgical modalities, namely, combined anterior-posterior (A-P) instrumented fusion and posterior fusion alone, in athetoid-type CP patients with cervical myelopathy (CM).

METHODS

We analyzed 63 patients with athetoid-CP and CM who underwent posterior fusion only with LMS (group A, 35 patients) and A-P fusion (group B, 28 patients). The primary outcome was the 1- and 3-year fusion rates for the surgical segments. The secondary outcomes included the clinical outcomes based on pain intensity determined using the visual analog scale score, neck disability index, and 17-point Japanese Orthopedic Association score, radiological, and surgical outcomes.

RESULTS

Fusion was achieved at 3 years postoperatively in 22 of 35 patients (63%) in group A and in 26 of 28 patients (93%) in group B (P = 0.02). The posterior neck pain intensity was also significantly lower in group B than in group A 2 and 3 years postoperatively (P = 0.02 and 0.01, respectively). The incidence of screw loosening and implant-related problems was higher in group A (60%) than in group B (21%) (P = 0.01). The other clinical and radiological parameters were similar between the groups.

CONCLUSIONS

For athetoid CP-induced CM, combined A-P fusion would result in superior clinical and radiological outcomes compared to posterior fusion alone.

Microscope-assisted anterior cervical discectomy and fusion combined with posterior minimally invasive surgery through tubular retractors for multisegmental cervical spondylotic myelopathy: A retrospective study

This study aimed to investigate the clinical efficacy and outcome of combined microscope-assisted anterior cervical discectomy and fusion (ACDF) with posterior minimally invasive surgery through tubular retractors for patients with multisegmental cervical spondylotic myelopathy (MCSM).This retrospective study included 28 patients (19 males and 9 females) with multisegmental cervical spondylotic myelopathy, who underwent combined microscope-assisted ACDF with posterior minimally invasive surgery through tubular retractors in our single center between January 2012 and December 2016. The evaluated postoperative clinical outcomes were operation time, length of hospitalization, blood loss, levels of creatine phosphokinase isoenzyme MM (CPK-MM), Japanese Orthopedic Association (JOA) scores, visual analogue scale (VAS) scores, Cobb angle of C2-C7, and radiological assessments (included X-rays, computed tomography scans, and magnetic resonanceimaging images).The mean surgery time was 198.42 ± 17.53 minutes, the average hospitalization length of hospital was 7.59 ± 1.38 days, and the mean follow-up time was 13 ± 2.45 months. On average, about 36.42 ± 10.15 mL of blood was lost and CPK-MM increased to 331.75 ± 23.15 IU/mL postoperatively (P < .001). The mean modified JOA scores increased from 8.21 ± 0.69 preoperatively to 13.96 ± 1.57 postoperatively (P < .001), whereas the mean VAS scores decreased from 6.64 ± 1.28 preoperatively to 0.39 ± 0.50 postoperatively (P < .001). Cobb angle of C2-C7 increased from 13.86° ± 5.69° preoperatively to 14.10° ± 5.56° postoperatively (P = .16).In conclusion, combined microscope-assisted ACDF with posterior minimally invasive surgery through tubular retractors appears to be a safe and effective treatment for patients with MCSM.

Prevalence of complications after surgery in treatment for cervical compressive myelopathy: A meta-analysis for last decade

PURPOSE

We aim to perform a meta-analysis on prevalence of all kinds of operation-related complications following surgery treating cervical compressive myelopathy (CCM) and to provide reference for surgeons making surgical plan.

METHODS

An extensive search of literature was performed in PubMed/MEDLINE, Embase, the Cochrane library, CNKI, and WANFANG databases on incidence of operation-related complications from January 2007 to November 2016. Data was calculated and data analysis was conducted with STATA 12.0 and Revman 5.3.

RESULTS

A total of 107 studies included 1705 of 8612 patients (20.1%, 95% CI 17.3%-22.8%) on overall complications. The incidence of C5 plasy, cerebrospinal fluid (CSF), infection, axial pain, dysphagia, hoarseness, fusion failure, graft subsidence, graft dislodgment, and epidural hematoma is 5.3% (95% CI 4.3%-6.2%), 1.9% (95% CI 1.3%-2.4%), 2.8% (95% CI 1.7%-4.0%), 15.6% (95% CI 11.7%-19.5%), 16.8% (95% CI 13.6%-19.9%), 4.0% (95% CI 2.3%-5.7%), 2.6% (95% CI 0.2%-4.9%), 3.7% (95% CI 2.0%-5.5%), 3.4% (95% CI 2.0%-4.8%), 1.1% (95% CI 0.7%-1.5%), respectively. Patients with ossification of posterior longitudinal ligament (OPLL) (6.3%) had a higher prevalence of C5 plasy than those with cervical spondylotic myelopathy (CSM) (4.1%), and a similar trend in CSF (12.2% vs 0.9%). Individuals after laminectomy and fusion (LF) had highest rate of C5 plasy (15.2%), while those who underwent anterior cervical discectomy and fusion (ACDF) had the lowest prevalence (2.0%). Compared with patients after other surgical options, individuals after anterior cervical corpectomy and fusion (ACCF) have the highest rate of CSF (4.2%), infection (14.2%), and epidural hematoma (3.1%). Patients after ACDF (4.8%) had a higher prevalence of hoarseness than those with ACCF (3.0%), and a similar trend for dysphagia between anterior corpectomy combined with discectomy (ACCDF) and ACCF (16.8% vs 9.9%).

CONCLUSIONS

Based on our meta-analysis, patients with OPLL have a higher incidence of C5 palsy and CSF. Patients after LF have a higher incidence of C5 palsy, ACCDF have a higher incidence of dysphagia, ACCF have a higher incidence of CSF and infection and ACDF have a higher incidence of hoarseness. These figures may be useful in the estimation of the probability of complications following cervical surgery.