Spinal Instrumented Fusion in Combination with Botulinum Toxin Treatment for Cervical Myelopathy in Patients with Athetoid Cerebral Palsy
Main Article Content
Abstract
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.
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