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Cervical Myelopathy in Patients With Athetoid Cerebral Palsy

Furuya, Takeo, MD, PhD*; Yamazaki, Masashi, MD, PhD*; Okawa, Akihiko, MD, PhD*; Misawa, Sonoko, MD, PhD; Sakuma, Tsuyoshi, MD, PhD*; Takahashi, Hiroshi, MD, PhD*; Kato, Kei, MD*; Kuwabara, Satoshi, MD, PhD; Takahashi, Kazuhisa, MD, PhD*

doi: 10.1097/BRS.0b013e31827bc7e8
Cervical Spine
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Study Design. Retrospective clinical study.

Objective. To report the surgical outcomes of patients with cervical myelopathy associated with athetoid cerebral palsy and to assess whether a halo vest is necessary for postoperative external immobilization.

Summary of Background Data. Although a halo vest has remained the first choice for postoperative external immobilization of patients with cervical myelopathy associated with cerebral palsy, simplification of this method has been attempted in recent years. Studies focusing on postoperative external immobilization are rare.

Methods. Since 2001, 20 patients underwent surgery with posterior instrumented fusion or posterior fixation and anterior decompression with fusion with a year or longer follow-up. Before 2004, all patients were given a halo vest for postoperative external immobilization. After 2004, halo vests were not used, and when abnormal involuntary neck movements were severe, an intramuscular injection of botulinum toxin was administered before and after surgery. Surgical outcomes, surgical methods and complications were compared between the group that used a halo vest and the group that did not use a halo vest.

Results. In the halo vest group, the average Japanese Orthopedic Association score was 6.9 points before surgery and 9.3 points at 1-year follow-up. The average recovery rate was 25.0%. In the group without halo vest use, the average Japanese Orthopedic Association score was 5.8 points before surgery and 9.9 points at 1-year follow-up. The average recovery rate was 35.7%. The group without halo vest use achieved outcomes equal to those achieved in the group with halo vest use. The frequency of complications was less without halo vest use than with halo vest use.

Conclusion. No inferiority in clinical outcomes was seen if postoperative halo vest use was omitted. Progress in surgical instrumentation and injection of botulinum toxin may explain this result.

The clinical outcomes of patients with cervical myelopathy associated with athetoid cerebral palsy are reported. Results with or without use of a halo vest for postoperative external immobilization were compared. There were no statistically significant differences in clinical outcomes between patients with and without halo vest use.

*Spine Division, Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan; and

Department of Neurology, Chiba University Graduate School of Medicine, Chiba, Japan.

Address correspondence and reprint requests to Takeo Furuya, MD, PhD, Spine Division, Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine,1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan; E-mail: takeo1225@snow.plala.or.jp

Acknowledgment date: November 2, 2011. First revision date: February 6, 2012. Second revision date: May 21, 2012. Third revision date: September 4, 2012. Acceptance date: October 14, 2012.

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

© 2013 Lippincott Williams & Wilkins, Inc.