Cervical myelopathy in athetoid and dystonic cerebral palsy: retrospective study and literature review |
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Authors: | Raphael Jameson Celia Rech Christian Garreau de Loubresse |
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Institution: | 1. Orthopaedic Department, Raymond Poincaré Hospital, 104, Bvd Raymond Poincaré, 92380, Garches, France 3. 42 rue de Sablonville, 92200, Neuilly sur Seine, France 2. Service de Réadaptation Fonctionnelle, 104, Bvd Raymond Poincaré, 92380, Garches, France
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Abstract: | The early onset of degenerative cervical lesions has been well described in patients suffering from athetoid or dystonic cerebral
palsy. Myelopathy can occur and aggravate of their unstable neurological status. Diagnosis and treatment are delayed and disrupted
by the abnormal movements. This retrospective study was implemented to evaluate the symptoms, the anatomical findings, and
the surgical management of seven patients from 20 to 56 years old suffering from cervical myelopathy and athetoid or dystonic
cerebral palsy. The mean delay in diagnosis was 15 months and the mean follow-up was 33 months. The initial symptoms were
spasticity, limbs weakness, paresthesias and vesico-sphinteric dysfunction. In addition to abnormal movements, imaging demonstrated
disc herniation, spinal stenosis and instability. All patients were managed surgically by performing simultaneous spinal cord
decompression and fusion. Two patients benefited from preoperative botulinum toxin injections, which facilitated postoperative
care and immobilization. Strict postoperative immobilization was achieved for 3 months by a Philadelphia collar or a cervico-thoracic
orthosis. All patients improved functionally with a mean Japanese Orthopaedic Association score gain of 1.5 points, in spite
of the permanent disabilities of the myelopathy. Complications occurred with wound infection, metal failure and relapse of
cervical myelopathy at an adjacent level in one case each. All the previous authors advised against isolated laminectomy but
no consensus emerged from the literature analysis. Spinal fusion is usually recommended but can be complicated by degenerative
adjacent deterioration. Surgical management provides good outcomes but requires a long-term follow-up. |
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Keywords: | Athetoid cerebral palsy Dystonia Cervical myelopathy Abnormal movements |
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