Laminoplasty and Pedicle Screw Fixation for Cervical Myelopathy Associated With Athetoid Cerebral Palsy

Abstract

Retrospective case series. To evaluate the outcomes after laminoplasty and posterior spinal fusion using pedicle screws for cervical myelopathy associated with athetoid cerebral palsy. A variety of surgical procedures have been reported including decompression without fusion, spinal fusion by anterior, posterior, or circumferential approach in this population. However, involuntary neck movements bring risk of postoperative neurological deterioration due to progression of kyphosis, pseudoarthrosis, or adjacent segmental degeneration. A consecutive series of 17 patients who underwent midline T-saw laminoplasty and posterior spinal fusion using pedicle screws were retrospectively reviewed. The mean age was 52 years (8 females and 9 males) at the time of surgery. The mean follow-up was 71 months. Radiographical measures were made in change of Cobb angle of sagittal plane from C2 to C7 and accuracy of pedicle screws. Barthel Index that shows independence in activities of daily life and the Japanese Orthopaedic Association score were also evaluated. Preoperative Cobb angle of sagittal plane from C2 to C7 measured 11.0°± 14.5° of kyphosis, which improved to 1.5°± 12.7° postoperatively (P < 0.05). Solid posterior bony fusion was achieved in all cases without rigid orthosis such as halo vest. There were 2 cases of adjacent segmental instability, which required additional surgery. Nineteen (13%) out of the 138 screws showed deviation from the pedicle with postoperative computed tomography. However, there were no neurovascular complications during or after the surgery in any cases. Postoperative Japanese Orthopaedic Association score and Barthel Index significantly improved in 32% ± 16%, and 48% ± 26%, respectively. Laminoplasty and pedicle screw fixation provided strong internal fixation and improved neurological function and activities of daily living for cervical myelopathy associated with athetoid cerebral palsy. 4.