Involuntary Neck Movements Research Articles

More Than 10-year Follow-up After Laminoplasty and Pedicle Screw Fixation for Cervical Myelopathy Associated With Athetoid Cerebral Palsy.

Retrospective case series. The aim of this study was to investigate the clinical outcomes >10 years following laminoplasty and pedicle screw fixation for cervical myelopathy associated with athetoid cerebral palsy (CP). Surgery for cervical myelopathy associated with CP remains a challenge because of perioperative instrumentation failure and adjacent segment problems due to patients' repetitive involuntary neck movements with deformity of the cervical spine. A single-center series of 14 patients were reviewed. The patients comprised seven women and seven men with a mean age of 52 years at the time of surgery. The mean follow-up period was 12.5 years. The Barthel index (BI), which shows independence in activities of daily life, and Japanese Orthopaedic Association (JOA) score were assessed. Radiographic evaluation included changes of the C2-C7 angle in the sagittal plane, fusion rate, adjacent segment degeneration, and instrument failure. The 10-year BI and JOA score significantly improved at 36% and 31%, respectively. The preoperative Cobb angle of the sagittal plane from C2-C7 measured 11.9° of kyphosis, which improved to 0.8° of lordosis. In the radiographic analysis, 35% (proximal) and 21% (distal) of the adjacent segment showed progression in degeneration of more than one grade after 10 years. More than 90% of the patients who underwent magnetic resonance imaging showed progressive disc degeneration on either side after 10 years. Autofusion inside the disc or anterior vertebral bony bridging was observed in 86% of intervertebral levels without anterior procedures. The procedure showed favorable initial stability and maintained favorable clinical outcomes in patients with CP. More than 90% of the patients showed disc degeneration on either side. The rate of proximal adjacent segment degeneration was higher than that of distal segments with or without symptoms at the >10-year follow-up. 4.

Spinal Instrumented Fusion in Combination with Botulinum Toxin Treatment for Cervical Myelopathy in Patients with Athetoid Cerebral Palsy

Objective. To report the surgical outcomes and the details of perioperative botulinum toxin treatment of patients with cervical myelopathy associated with athetoid cerebral palsy.Summary of Background Data. Recently, injections of botulinum toxin have been widely used to decrease spasticity and involuntary movements associated with athetosis or dystonia. Studies focusing on the details of botulinum toxin treatment are rare.Methods. For patients who underwent surgery with spinal instrumented fusion in combination with perioperative botulinum toxin treatment, surgical outcomes, the details of botulinum toxin treatment and perioperative complications were investigated retrospectively.Results: Of 17 patients, 15 underwent surgery by posterior methods, and 2 underwent anterior and posterior combined procedures. The mean preoperative Japanese Orthopedic Association (JOA) score was 6.9±2.4. At the final follow-up visit, the mean JOA score was 9.2±3.3, and the mean recovery rate was 23%. Botulinum toxin treatment suppressed involuntary neck movements in all patients. Halo vest immobilization was adapted for six patients preoperatively and for four patients postoperatively. The major complication in relation to surgery was implant failure. One patient developed mild dysphasia after an injection of botulinum toxin, but it improved after conservative therapy.Discussion & Conclusion: Botulinum toxin treatment was performed safely and was effective in the management of involuntary neck movements. With botulinum toxin treatment, we were able to obtain relatively good surgical outcomes even if we did not use halo vest immobilization in many cases. However, we still faced a high rate of implant failures in the postoperative period. Using relatively strong external fixation, such as halo vest immobilization, together with botulinum toxin treatment may be an option for cervical myelopathy in patients with severe involuntary neck movements.

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

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.

Cervical Myelopathy in Patients With Athetoid Cerebral Palsy

Retrospective clinical study. 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. 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. 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. 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. 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.

Orolingual Dyskinesia and Involuntary Neck Movements Caused by Phenytoin Intoxication

Orolingual Dyskinesia and Involuntary Neck Movements Caused by Phenytoin Intoxication

Multiple neck operations in a patient with severe motor tics because of Tourette’s syndrome: a case report

IntroductionIn patients with Tourette’s syndrome who have severe motor tics, involuntary neck movements can enhance degenerative changes in the cervical spine, occasionally causing myelopathy. There have been a limited number of reports on surgical treatment for cervical myelopathy caused by Tourette’s syndrome, and a consensus for surgical treatment has not been fully established. To the best of our knowledge, this is the first report that describes a case of cervical myelopathy in a patient with Tourette’s syndrome with severe motor tics who has undergone multiple surgeries of the cervical spine.Case presentationA 44-year-old Asian man with severe motor tics due to Tourette’s syndrome presented with cervical myelopathy. Previously, he had undergone an anterior discectomy and spinal fusion with ceramics at the C3-C4 and C5-C6 levels, but required further surgery because of displacement of the ceramics. After the second operation, he developed compression myelopathy at the sandwiched (C4-C5) disc level, and had to undergo a C4-C5 anterior discectomy and spinal fusion, which was unsuccessful.As a salvage operation, we performed a C3-C7 decompression and spinal fusion from both the anterior and posterior approaches. By thorough postoperative external immobilization of his neck, our patient’s spinal fusion was successful and his neurological improvements were maintained for more than 10 years.ConclusionsPatients with Tourette’s syndrome with cervical myelopathy are at risk of having multiple neck operations to correct their symptoms. Postoperative immobilization and the correct selection of surgical procedure are quite important for successful spinal fusion and for avoiding complications at adjacent levels in these patients.

Long-term results of operative treatment for cervical spondylotic myelopathy in patients with athetoid cerebral palsy: an over 10-year follow-up study.

A retrospective radiographic and medical record analysis of patients followed for more than 10 years after operative treatment for cervical spondylotic myelopathy complicating athetoid cerebral palsy. To describe the incidence of late neurologic deterioration and spinal deformity after operative treatment for cervical spondylotic myelopathy in athetoid cerebral palsy. The possibility of recurrence of symptoms after operative treatment for cervical spondylotic myelopathy seems greater in patients with athetoid cerebral palsy because of their involuntary neck movements. Although there are several reports of surgical results, long-term follow-up studies are very rare. Ten patients with athetoid cerebral palsy were evaluated over an average of 15 years after anterior decompression (corpectomy) and fusion (three patients), laminectomy (one patient), and laminoplasty (six patients, four with accompanying posterior fusion). They averaged 45 years of age at surgery. Surgical results were assessed using Kurokawa's method. Late neurologic deterioration was based on decrement in the JOA score, and the evolution of kyphosis or instability of the cervical spine was observed radiographically. Surgical results at the most improved period were good or excellent in all 10 patients. Eight showed late neurologic deterioration, however, and six of them deteriorated from 8 to 13 years after surgery, largely because of progressive deformity. Long-term follow-up evaluation is essential in any type of operation, particularly with patients with athetoid cerebral palsy who often undergo this operation in their 30s or 40s.

De novo expansion of a CAG repeat in a Japanese patient with sporadic Huntington’s disease

A 49-year-old man was admitted to our hospital complaining of dysarthria and involuntary movements of his neck and extremities. He had first begun to experience involuntary neck movements at the age of 40 and his symptoms gradually progressed thereafter. There was no family history of neurological disorders. On admission he showed memory disturbance, dysarthria, and choreic movements. The involuntary movements affected his face, neck, trunk, and extremities. MRI of the brain revealed atrophy of both the cerebral cortex and the head of the caudate nucleus. DNA samples for molecular analysis were obtained from the patient and both of his parents. In this pedigree, the father carried a premutated allele of 35 CAG repeats and transmitted an expanded allele of 43 CAG repeats to his son. Paternity and maternity were analyzed using a microsatellite marker located in a different chromosome. To our knowledge, this is the first report of a sporadic case of Huntington’s disease in a non-caucasian population in which the disease prevalence is much lower than that in the caucasian population. A new mutation in the current Japanese population which shares the same mechanism as de novo mutation in Caucasians may have contributed to the frequency of HD in Japan at the present time.

Surgical Treatment of Cervical Spondylotic Radiculomyelopathy with Abnormal Involuntary Neck Movements

Cervical spondylotic myelopathy usually arises in patients in their late 40s or early 50s, most frequently at the C5/6 and C6/7 levels. Recently, excellent results have been attained with microsurgery in cases of cervical spondylosis. On the other hand, treatment of cervical spondylotic myelopathy in patients with athetoid dystonic cerebral palsy entails several problems. The authors report three cases of such troublesome myelopathy. A 34-year-old male with severe athetoid movement showed cervical spondylotic myelopathy. Myelography and magnetic resonance (MR) imaging demonstrated compression of the spinal cord through the C3-C5 levels. A 47-year-old female with athetoid dystonic cerebral palsy presented myelopathy. Myelography and MR imaging showed instability and spinal cord compression at the C5/6 level. A 34-year-old male with spasmodic torticollis showed C6 radiculopathy due to cervical disc hernia at the C5/6 level. Cervical anterior decompression with interbody fusion brought temporary improvement in all the three patients. However, such problems as slippage of Halo-vest, difficulty in eating during Halo-vest fixation, relapse of neurological deficit, were experienced. Due to postoperative cervical instability, cervical laminectomy is considered to be contraindicated in such patients. Anterior decompression with bone fusion has been reported effective, but, if athetoid dystonia continues, there is a potential for myelopathic deterioration due to spondylotic changes adjacent to the fused vertebrae.