Harada Takahiro, Nakamae Toshio, Kamei Naosuke, Fujimoto Yoshinori, Manabe Hideki, Tanaka Nobuhiro, Fujiwara Yasushi, Yamada Kiyotaka, Tsuchikawa Yuji, Morisako Taiki, Maruyama Toshiaki, Adachi Nobuo
Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
Department of Orthopaedic Surgery, JA Hiroshima General Hospital, Hiroshima, Japan.
Eur J Orthop Surg Traumatol. 2022 Oct;32(7):1283-1289. doi: 10.1007/s00590-021-03109-7. Epub 2021 Aug 29.
Surgical treatment for cervical myelopathy with athetoid cerebral palsy remains unestablished. Instrumented fusion is reported to have good clinical results; however, there are no data of decompression surgery for this pathology in recent years. This study aimed to assess the surgical outcomes of laminoplasty with or without posterior instrumented fusion for cervical myelopathy in patients with athetoid cerebral palsy.
A multi-centre surgical series of patients with cervical myelopathy and athetoid cerebral palsy were enrolled in this study. All patients showed symptoms and signs suggestive of cervical myelopathy and underwent laminoplasty with or without instrumented fusion. The Japanese Orthopaedic Association (JOA) score, Barthel index (BI), and changes in the C2-C7 sagittal Cobb angle in the lateral plain radiograph were analysed.
There were 25 patients (16 men and 9 women; mean age, 54.4 ± 10.8 years) with cervical myelopathy and athetoid cerebral palsy who underwent surgical treatment. The mean follow-up period was 41.9 ± 35.6 months. Overall, the BI significantly improved after surgery, whereas the JOA score and C2-C7 angle did not improve postoperatively. The recovery rate of the JOA score in the laminoplasty group was significantly higher than that of the fusion group (P = 0.02).
Cervical laminoplasty with or without instrumented fusion for treating cervical myelopathy due to athetoid cerebral palsy is effective in improving activities of daily living. Cervical laminoplasty may be an effective and less invasive surgical method for selective patients, especially for those with small involuntary movements and no remarkable cervical kyphosis nor instability.
针对手足徐动型脑瘫所致的脊髓型颈椎病，外科治疗方法尚未确立。据报道，器械辅助融合术具有良好的临床效果；然而，近年来尚无关于此类病症减压手术的数据。本研究旨在评估对于手足徐动型脑瘫患者脊髓型颈椎病行或不行后路器械辅助融合术的椎板成形术的手术效果。
本研究纳入了一个多中心的脊髓型颈椎病合并手足徐动型脑瘫患者的手术系列。所有患者均表现出提示脊髓型颈椎病的症状和体征，并接受了行或不行器械辅助融合术的椎板成形术。分析了日本骨科协会（JOA）评分、巴氏指数（BI）以及侧位X线平片中C2-C7矢状面Cobb角的变化。
25例（16例男性和9例女性；平均年龄54.4±10.8岁）脊髓型颈椎病合并手足徐动型脑瘫患者接受了手术治疗。平均随访期为41.9±35.6个月。总体而言，术后BI显著改善，而JOA评分和C2-C7角术后未改善。椎板成形术组的JOA评分恢复率显著高于融合术组（P = 0.02）。
对于手足徐动型脑瘫所致脊髓型颈椎病，行或不行器械辅助融合术的颈椎椎板成形术在改善日常生活活动方面是有效的。颈椎椎板成形术对于部分患者可能是一种有效且侵入性较小的手术方法，特别是对于那些有轻微不自主运动且无明显颈椎后凸或不稳定的患者。
