Yang Jae Jun, Choi Jun Young, Lee Dong-Ho, Hwang Chang Ju, Cho Jae Hwan, Park Sehan
Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Goyangsi, Republic of Korea.
Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Global Spine J. 2025 Jan;15(1):21-30. doi: 10.1177/21925682241247486. Epub 2024 Apr 17.
National population-based cohort study.
The overall complication rate for patients with athetoid cerebral palsy (CP) undergoing cervical surgery is significantly higher than that of patients without CP. The study was conducted to compare the reoperation and complication rates of anterior fusion, posterior fusion, combined fusion, and laminoplasty for degenerative cervical myelopathy/radiculopathy in patients with athetoid cerebral palsy.
The Korean Health Insurance Review and Assessment Service national database was used for analysis. Data from patients diagnosed with athetoid CP who underwent cervical spine operations for degenerative causes between 2002 and 2020 were reviewed. Patients were categorized into four groups for comparison: anterior fusion, posterior fusion, combined fusion, and laminoplasty.
A total of 672 patients were included in the study. The overall revision rate was 21.0% (141/672). The revision rate was highest in the anterior fusion group (42.7%). The revision rates of combined fusion (11.1%; hazard ratio [HR], .335; = .002), posterior fusion (13.8%; HR, .533; = .030) were significantly lower than that of anterior fusion. Revision rate of laminoplasty (13.1%; HR, .541; = .240) was also lower than anterior fusion although the result did not demonstrate statistical significance.
Anterior fusion presented the highest reoperation risk after cervical spine surgery reaching 42.7% in patients with athetoid CP. Therefore, anterior-only fusion in patients with athetoid CP should be avoided or reserved for strictly selected patients. Combined fusion, with the lowest revision risk at 11.1%, could be safely applied to patients with athetoid CP.
基于全国人口的队列研究。
患有手足徐动型脑瘫（CP）的患者接受颈椎手术的总体并发症发生率显著高于无CP的患者。本研究旨在比较手足徐动型脑瘫患者因退行性颈椎病/神经根病接受前路融合术、后路融合术、联合融合术和椎板成形术的再次手术率和并发症发生率。
使用韩国健康保险审查和评估服务国家数据库进行分析。回顾了2002年至2020年间因退行性病因接受颈椎手术的被诊断为手足徐动型CP患者的数据。患者被分为四组进行比较：前路融合术、后路融合术、联合融合术和椎板成形术。
共有672名患者纳入研究。总体翻修率为21.0%（141/672）。前路融合组的翻修率最高（42.7%）。联合融合术（11.1%；风险比[HR]，0.335；P = 0.002）、后路融合术（13.8%；HR，0.533；P = 0.030）的翻修率显著低于前路融合术。椎板成形术的翻修率（13.1%；HR，0.541；P = 0.240）也低于前路融合术，尽管结果未显示统计学意义。
前路融合术在颈椎手术后的再次手术风险最高，在手足徐动型CP患者中达到42.7%。因此，应避免对手足徐动型CP患者仅进行前路融合术，或仅适用于严格筛选的患者。联合融合术的翻修风险最低，为11.1%，可安全应用于手足徐动型CP患者。
