Watanabe Kazuyuki, Otani Koji, Nikaido Takuya, Kato Kinshi, Kobayashi Hiroshi, Yabuki Shoji, Kikuchi Shin-Ichi, Konno Shin-Ichi
Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan.
Asian Spine J. 2017 Dec;11(6):928-934. doi: 10.4184/asj.2017.11.6.928. Epub 2017 Dec 7.
Observational cohort study.
To assess the surgical outcomes of posterior decompression and fusion for cervical myelopathy in patients with athetoid cerebral palsy.
Patients with athetoid cerebral palsy demonstrate involuntary movements and develop severe cervical spondylosis with kyphosis. In these patients, surgery is often performed at an early age because of myelopathy. A few studies have reported about the long-term outcomes of surgical treatment; however, they contain insufficient information.
From 2003 to 2008, 13 patients with cervical myelopathy due to athetoid cerebral palsy underwent posterior fusion surgery and were included in this study. The Japanese Orthopaedic Association (JOA) score, neck disability index (NDI), C2-7 angle on radiography, and need for additional surgical treatment were examined at 1 and 5 years postoperatively.
The mean C2-7 angle was -10.5°±21.1° preoperatively and was corrected to -2.9°±13.5° immediately postoperatively. This improvement was maintained for 5 years. The JOA score was 9.5±2.5 preoperatively and 12.2±1.7 at the 5-year follow-up. NDI was 17±6.9 preoperatively and 16±7.5 at the 5-year follow-up. Patient satisfaction with surgery on a 100-point scale was 62.2±22.5 at the 5-year follow-up. Three patients needed additional surgery for loosening of screws. These results demonstrate good surgical outcomes for posterior fusion at 5 years.
Posterior decompression and fusion should be considered a viable option for cervical myelopathy in patients with athetoid cerebral palsy.
观察性队列研究。
评估患有手足徐动型脑瘫的脊髓型颈椎病患者后路减压融合术的手术效果。
手足徐动型脑瘫患者表现出不自主运动，并发展为严重的伴有后凸畸形的颈椎病。在这些患者中，由于脊髓病，手术通常在早期进行。少数研究报告了手术治疗的长期效果；然而，它们包含的信息不足。
2003年至2008年，13例因手足徐动型脑瘫导致脊髓型颈椎病的患者接受了后路融合手术，并纳入本研究。在术后1年和5年时检查日本骨科协会（JOA）评分、颈部残疾指数（NDI）、X线片上的C2-7角度以及是否需要额外的手术治疗。
术前平均C2-7角度为-10.5°±21.1°，术后立即矫正至-2.9°±13.5°。这种改善持续了5年。术前JOA评分为9.5±2.5，5年随访时为12.2±1.7。术前NDI为17±6.9，5年随访时为16±7.5。在5年随访时，患者对手术的满意度以100分制计为62.2±22.5。3例患者因螺钉松动需要再次手术。这些结果表明后路融合术在5年时具有良好的手术效果。
后路减压融合术应被视为患有手足徐动型脑瘫的脊髓型颈椎病患者的一种可行选择。
