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Long-term surgical outcomes of cervical myelopathy with athetoid cerebral palsy

 Keung Nyun Kim  ;  Poong Gee Ahn  ;  Mi Jung Ryu  ;  Dong Ah Shin  ;  Seong Yi  ;  Do Heum Yoon  ;  Yoon Ha 
 EUROPEAN SPINE JOURNAL, Vol.23(7) : 1464-1471, 2014 
Journal Title
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Adult ; Aged ; Atlanto-Axial Joint/surgery ; Botulinum Toxins, Type A/therapeutic use ; Cerebral Palsy/complications* ; Cervical Vertebrae/surgery* ; Female ; Follow-Up Studies ; Humans ; Joint Instability/etiology ; Joint Instability/surgery* ; Kyphosis/surgery* ; Male ; Middle Aged ; Neuromuscular Agents/therapeutic use ; Patient Outcome Assessment ; Postoperative Complications ; Prognosis ; Reoperation ; Retrospective Studies ; Spinal Cord Compression/etiology ; Spinal Cord Compression/surgery* ; Spinal Fusion ; Visual Analog Scale ; Young Adult
Cervical myelopathy ; Athetoid cerebral palsy ; Botulinum toxin ; Surgical outcome
PURPOSE: To understand the long-term surgical outcomes and prognostic factors for the operative treatment of cervical myelopathy (CM) in patients with athetoid cerebral palsy (ACP). METHODS: We retrospectively reviewed 24 patients with ACP who underwent surgery for CM at our hospital between March 2002 and June 2008. All patients had more than 5 years follow-up. Anterior fusion (11 patients), posterior fusion (1 patient), or combined anterior and posterior (AP) fusion (7 patients) and C1-2 fusion (5 patients) surgeries were performed. Surgical outcomes (average follow-up 102 months), as assessed using modified JOA (mJOA) scores, the Neck Disability Index (NDI), and a visual analog scale (VAS) were compared between the preoperative and postoperative states. RESULTS: Preoperatvie cervical kyphosis decreased mJOA scores significantly. Long-term follow-up clinical outcomes demonstrated that 10 patients showed favorable (excellent and good) outcomes and 11 patients had non-favorable (fair and worse) outcomes. According to the mJOA scores, patients showed postoperative improvement (7.10-10.45). NDI decreased from 68.46 to 31.66. A second operation was done in seven cases due to instrument failure, progressive kyphotic deformities and adjacent segment degeneration. A preoperative botulinum toxin injection significantly decreased (p < 0.05) the incidence of a second operation. CONCLUSIONS: Patients with ACP have high incidence of instrument failure. Strong surgical fixation, bone fusion and perioperative immobilizations using botulinum toxin injection should be carefully planned preoperatively.
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1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Keung Nyun(김긍년)
Shin, Dong Ah(신동아) ORCID logo https://orcid.org/0000-0002-5225-4083
Ahn, Poong Gee(안풍기)
Yoon, Do Heum(윤도흠) ORCID logo https://orcid.org/0000-0003-1452-5724
Yi, Seong(이성)
Ha, Yoon(하윤)
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