Surgical treatment of cervical spondylotic myelopathy complicating athetoid cerebral palsy

Abstract

Operative treatment was performed in nine patients with cervical spondylotic myelopathy complicating athetoid cerebral palsy. The first two patients were freated by laminectomy, and the other seven by anterior interbody fusion. The symptoms in both the laminectomy patients improved after operation, but became worse again when cervical instability developed; they then had to have an anterior fusion in addition. In six of the seven patients who had primary anterior fusion a halo-cast (or a halo-vest) was used to keep the cervical spine immobile, and good bony fusion was obtained with satisfactory results. However, in one patient no halo apparatus was used, bony union did not occur and the radiculopathy reappeared. In cervical myelopathy complicating athetoid cerebral palsy laminectomy is contra-indicated; anterior fusion combined with a halo apparatus is, however, satisfactory.

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

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

“…Dysarthria is also often present so the help of the entourage is necessary to detect early neurological changes and to perform an accurate clinical evaluation [7,14,16,18]. Decrease in abnormal movements must be considered as an alarming sign even though it could be interpreted as an improvement.…”

“…Surgical treatment always requires spinal cord decompression by anterior approach (corporectomy and discectomy) or by posterior approach (laminectomy and laminoplasty) [2,7,9,13,17,19,22,23]. No isolated cervical laminectomy should ever be performed alone [2,11,14,17,18].…”

“…In athetoid or dystonic patients, strict postoperative immobilization is always necessary after spinal fusion [9,16,18,23]. Some authors used a halo vest up to 6 months, but the rate of complications was as high as 40%, with pinloosening or pin-site infection [11].…”

Pediatric cervical spine instability

“…The combination of disc degeneration and listhetic instability predisposes these patients to progressive neurological deficit. Symptoms range from mild brachialgia to tetraparesia [90][91][92]. Treatment is mainly surgical with posterior fusion with or without instrumentation.…”