Iwamuro Hirokazu, Takahashi Hiroshi, Ide Katsuhisa, Nakauchi Jun, Taniguchi Makoto
Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashidai, Fuchu, Tokyo 183-0042, Japan.
No Shinkei Geka. 2003 Sep;31(9):1015-20.
Patients with spasmodic torticollis secondary to athetoid cerebral palsy may develop symptomatic degenerative cervical disc disease or spondylosis. In these cases, peri-operative stabilization of the cervical spine is considered to be difficult and recurrence occurs frequently. We reported a case with cervical spondylosis induced by athetoid cerebral palsy. A 44-year-old female with athetoid cerebral palsy had suffered from secondary spasmodic torticollis. 7 years previously, she had been admitted to our hospital for the first time with complaints of gait disturbance, dysesthesia and hypesthesia in all extremities. CT-myelography and MRI showed disc degeneration and spondylosis at the level of C4/5 and C5/6, compressing the spinal cord. She underwent C5 vertebrectomy and C4-6 anterior fusion. However, due to cervical dystonia, it was difficult for her to wear a Philadelphia collar, so she had to under go complete bed rest for postoperative neck stabilization. Her symptoms improved after the operation. 5 years after the first operation, she complained of gait disturbance and sensory disturbance, again. MRI showed compression of the spinal cord at C2-C4, rostral to the level of the previous surgical area. So we planned the second operation. Prior to the operation, we used botulinum A toxin to reduce the athetoid movement of the neck. And we performed C3-6 expansive laminoplasty and partial laminectomy of C2 and C7 laminae. After the second operation, she was able to wear the Philadelphia collar without trouble and her neurological condition improved again. Botulinum A toxin was very effective to control the spasmodic torticollis peri-operatively in this case with cervical dystonia.
患有手足徐动型脑瘫继发痉挛性斜颈的患者可能会出现症状性退行性颈椎间盘疾病或颈椎病。在这些情况下，颈椎的围手术期稳定被认为是困难的，且复发频繁。我们报告了一例由手足徐动型脑瘫引起的颈椎病病例。一名44岁患有手足徐动型脑瘫的女性患有继发性痉挛性斜颈。7年前，她首次因步态障碍、四肢感觉异常和感觉减退入院。CT脊髓造影和MRI显示C4/5和C5/6水平的椎间盘退变和颈椎病，压迫脊髓。她接受了C5椎体切除术和C4 - 6前路融合术。然而，由于颈部肌张力障碍，她难以佩戴费城颈托，因此术后颈部稳定只能完全卧床休息。术后她的症状有所改善。首次手术后5年，她再次出现步态障碍和感觉障碍。MRI显示在先前手术区域上方的C2 - C4水平脊髓受压。于是我们计划进行第二次手术。手术前，我们使用A型肉毒杆菌毒素来减少颈部的手足徐动运动。并且我们进行了C3 - 6扩大椎板成形术以及C2和C7椎板的部分椎板切除术。第二次手术后，她能够顺利佩戴费城颈托，神经状况再次改善。在这个伴有颈部肌张力障碍的病例中，A型肉毒杆菌毒素在围手术期控制痉挛性斜颈非常有效。
