Surgical Treatment of Cervical Myeloradiculopathy Associated with Movement Disorders

The early onset of degenerative cervical lesions has been well described in patients suffering from athetoid or dystonic cerebral palsy. Myelopathy can occur and aggravate of their unstable neurological status. Diagnosis and treatment are delayed and disrupted by the abnormal movements. This retrospective study was implemented to evaluate the symptoms, the anatomical findings, and the surgical management of seven patients from 20 to 56 years old suffering from cervical myelopathy and athetoid or dystonic cerebral palsy. The mean delay in diagnosis was 15 months and the mean follow-up was 33 months. The initial symptoms were spasticity, limbs weakness, paresthesias and vesico-sphinteric dysfunction. In addition to abnormal movements, imaging demonstrated disc herniation, spinal stenosis and instability. All patients were managed surgically by performing simultaneous spinal cord decompression and fusion. Two patients benefited from preoperative botulinum toxin injections, which facilitated postoperative care and immobilization. Strict postoperative immobilization was achieved for 3 months by a Philadelphia collar or a cervico-thoracic orthosis. All patients improved functionally with a mean Japanese Orthopaedic Association score gain of 1.5 points, in spite of the permanent disabilities of the myelopathy. Complications occurred with wound infection, metal failure and relapse of cervical myelopathy at an adjacent level in one case each. All the previous authors advised against isolated laminectomy but no consensus emerged from the literature analysis. Spinal fusion is usually recommended but can be complicated by degenerative adjacent deterioration. Surgical management provides good outcomes but requires a long-term follow-up.

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“…Cervical spinal stenosis and instability were found to be more frequent in athetoid patients than in the controlled group [12,13,16,18,24].…”

Section: Discussionmentioning

confidence: 92%

Cervical myelopathy in athetoid and dystonic cerebral palsy: retrospective study and literature review

2010

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“…Las posturas distónicas y los movimientos atetósicos producen fuerzas anormales de rotación y flexión que conllevan una inestabilidad dinámica en todos los niveles cervicales, que acaba generando cambios espondilóticos en edades juveniles. Los niveles más frecuentemente afectados en este tipo de paciente son C3-C4 y C4-C5 4,15,22,23 . Esta característica es diferencial con respecto a la común enfermedad degenerativa cervical en pacientes añosos, que afecta con más frecuencia a segmentos más distales (C6 y C7 sobre todo).…”

Section: Discussionunclassified

“…Los primeros intentos quirúrgicos han sido abordajes posteriores, casi exclusivamente laminectomías descompresivas 2,14 . Esta técnica produce una mejoría inicial, pero a corto-mediano plazo se asocia con un aumento de la inestabilidad y fracaso precoz con consecuente recidiva de los síntomas; de hecho varios autores consideran contraindicada la laminectomía en este subgrupo de pacientes 2,11,14,20,22 . De forma aislada, la laminoplastia ha demostrado eficacia, asociada a la relajación muscular 20 .…”

Section: Discussionunclassified

“…De hecho, las alteraciones en el tono y la movilidad de la musculatura cervical generan un estrés que es responsable del fallo precoz de la artrodesis. Por esto varios autores abogan por la utilización de sistemas de fijación rígida externa en el postoperatorio y durante periodos más o menos largos 15,22 . Otros autores han intentado utilizar relajantes musculares en el perioperatorio, como la toxina botulínica 1 , para reducir el hipertono y los movimientos atetósicos, que en el postoperatorio suelen tener incluso un aumento en intensidad debido al dolor postquirúrgico.…”

Section: Discussionunclassified

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Artrodesis combinada anterior y posterior en paciente con parálisis cerebral atetósica que desarrolla mielopatía cervical degenerativa: Caso clínico y revisión de la literatura

et al. 2011

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“…Several types of spinal surgery (laminectomy, anterior(-posterior) decompression with intercorporal fusion) with or without immobilization (halo-vest, hard or soft collars depending on the type of spinal surgery) may ameliorate symptoms. One has to be alert to secondary problems as spinal instability, pseudarthrosis and adjacent-level disease [Konrad et al 2004;Wong et al 2005;Loher et al 2006]. Spinal surgery in dystonia is further complicated by continuous mechanical forces due to dystonic posture, which can be alleviated by preoperative and postoperative use of BoNT or DBS [Traynelis et al 1992;Adler et al 1996;Racette et al 1998;Krauss et al 2002;Tonomura et al 2007].…”

Section: Orthopaedic and Neurological Complaintsmentioning

confidence: 99%

Current and future medical treatment in primary dystonia

Delnooz

Warrenburg

2012

Ther Adv Neurol Disord

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Dystonia is a hyperkinetic movement disorder, characterized by involuntary and sustained contractions of opposing muscles causing twisting movements and abnormal postures. It is often a disabling disorder that has a significant impact on physical and psychosocial wellbeing. The medical therapeutic armamentarium used in practice is quite extensive, but for many of these interventions formal proof of efficacy is lacking. Exceptions are the use of botulinum toxin in patients with cervical dystonia, some forms of cranial dystonia (in particular, blepharospasm) and writer's cramp; deep brain stimulation of the pallidum in generalized and segmental dystonia; and high-dose trihexyphenidyl in young patients with segmental and generalized dystonia. In order to move this field forward, we not only need better trials that examine the effect of current treatment interventions, but also a further understanding of the pathophysiology of dystonia as a first step to design and test new therapies that are targeted at the underlying biologic and neurophysiologic mechanisms. http://tan.sagepub.com dystonia are given intramuscularly, often under electromyography (EMG) guidance, and need to be repeated every 3-6 months. Contraindications for the use of BoNT include history of neuromuscular disease, e.g. myasthenia gravis, LambertEaton syndrome or motor neuron disease, and a history of hypersensitivity to BoNT, albumin or saline. BoNT injections are also contraindicated in combination with aminoglycoside, penicillamine, quinine and calcium-channel blockers as the effect of these drugs may be potentiated. As teratogenicity of BoNT is still unknown, it is advised not to use BoNT during pregnancy and lactation. Keywords Cervical dystoniaBoNT injections are the first-line therapy for cervical dystonia (CD). Meta-analysis of several double-blind, placebo-controlled trials have demonstrated a beneficial effect of the BoNT type A (BoNT-A) versus placebo on multiple domains, such as dystonia severity, pain and the patient's and physician's subjective judgement. Adverse events are usually transient and mild. The most relevant side effects, of increasing frequency with higher doses and therefore dose-limiting, are neck weakness, dysphagia, dry mouth/sore throat and voice changes/hoarseness. Others are doseindependent and include pain at the site of injection, malaise, upper respiratory infection and headache [Costa et al. 2005b].BoNT also has proven long-term safety and efficacy. Several large case series have shown treatment efficacy up to 10 years, without longterm adverse effects [Blackie and Lees, 1990;Haussermann et al. 2004]. The occurrence of a secondary nonresponse, likely due to antibodies to BoNT or other components, was rare (1-2%) [Kessler et al. 1999;Haussermann et al. 2004;Brin et al. 2008]. Also primary nonresponse is seen, but reports documenting its occurrence are sparse [Truong et al. 2005]. A comparison of efficacy and safety between two preparations of BoNT-A, (onabotulinumtoxinA [Botox ® ] and rimabotulinumtoxin...

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Surgical Treatment of Cervical Myeloradiculopathy Associated with Movement Disorders

Cited by 45 publications

References 32 publications

Cervical myelopathy in athetoid and dystonic cerebral palsy: retrospective study and literature review

Cervical myelopathy in athetoid and dystonic cerebral palsy: retrospective study and literature review

Artrodesis combinada anterior y posterior en paciente con parálisis cerebral atetósica que desarrolla mielopatía cervical degenerativa: Caso clínico y revisión de la literatura

Current and future medical treatment in primary dystonia

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