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Surgical Outcome of Cervical Spondylotic Myelopathy with Athetoid Cerebral Palsy
82S
Proceedings of the NASS 25th Annual Meeting / The Spine Journal 10 (2010) 1S–149S
METHODS: Reduction rates of opening angle and APD were calculated. On axial CT image at 6 M, and the fusion rate was evaluated by judging the hinge area as fusion or nonunion. Spinal cord compression was evaluated by 6 grade classification system (grade 0 to 5, 0:no compression, 1:subdural space compressed, 2:subdural space disappeared, 3:compression !1/4 of cord diameter, 4:compression 1/4-1/2 of cord diameter, 5:compression O1/2 of cord diameter) based on the MR sagittal images. RESULTS: Reduction rates of the AP diameter and the laminar angle were 9.4% and 10.2%, respectively, however, there was no significant difference from C3 to C7. The hinge was healed in 91% at 6 months. Immediate postoperative AP diameter and laminar angle did not correlate with the reduction rates (PO0.05). Severity of the cord compression on MR sagittal image improved from 2.961.3 degree to 1.461.0 degree postoperatively (P!0.0001). Nevertheless, the aggravation of spinal cord compression at the most stenotic level correlated with the decrease in the AP diameter and the laminar angle (P!0.05).There was a positive correlation between the APD and the laminar angle at 1 W and 6 M respectively (1 W; R50.645, P!0.0001, 6 M; R50.679, P!0.0001). Mean AP diameter was 8.461.8 mm preoperatively, which was increased immediately after surgery (14.563.0 mm) and decreased at 6 M significantly (13.163.0 mm) (P!0.0001). Mean laminar angle was 39.5613.6 at 1 W and reduced to 35.1612.3 at 6 M (P!0.0001). CONCLUSIONS: Reclosure of the opened lamina occurred in 10% of our patients during the 6 months following classic Hirabayashi open-door laminoplasty. Wider opening of the laminar does not prevent reclosure. Therefore, in order to prevent recurrent cord compression, other techniques, including the use of graft/spacer or tethering by suture anchor should be considered. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi: 10.1016/j.spinee.2010.07.219
177. Surgical Outcome of Cervical Spondylotic Myelopathy with Athetoid Cerebral Palsy Yoon Ha, MD, Seong Yi, Keungnyun Kim, MD, Do Heum Yoon, MD; Department of Neurosurgery, Yonsei University, Seoul, Republic of Korea BACKGROUND CONTEXT: Repetitive exaggerated neck movements in ACP may result in early degeneration of cervical spine requires operative managements. Moreover, these abnormal involuntary movements give rise to earlier instrument failure requires additional operative treatment and increase the incidence of recurrence of myelopathy. Understanding the outcome of operative management can aid in this decision-making process for the treatment of CSM in ACP. PURPOSE: To understand the mid to long-term follow-up surgical outcome including complications, and discuss the surgical strategy for operative treatment of CSM in ACP. STUDY DESIGN/SETTING: A retrospective analysis of medical record and radiographic findings of patients followed for more than one year after surgical treatment for cervical spondylotic myelopathy (CSM) associated with athetoid cerebral palsy (ACP). PATIENT SAMPLE: We retrospectively reviewed athetoid cerebral palsy 24 patients who underwent surgeries for CSM at our hospital from March 2002 to June 2008. Anterior fusion, posterior fusion or combined (anterior and posterior) surgeries were performed. Average follow-up duration is 26.4 months. OUTCOME MEASURES: JOA scores, Neck disability index, visual analogue scale. METHODS: Surgical outcome, as assessed by JOA scores, NDI (neck disability index) and visual analogue scale (VAS) were compared between preoperative and postoperative state. RESULTS: Anterior fusion was performed in 11 patients and posterior fusion was done in 1 patient. C1/2 posterior screw fixation was performed in 5 patients and combined approach (anterior and posterior fusion) was done
in 7 patients. According to JOA scores, patients showed postoperative improvement (7.26 to 10.79). NDI was decreasing from 64.94 to 41.76%. Revision surgery was in 7 cases, due to instrument failure related with progressive kphotic deformity after first surgery. Preoperative botulinum toxin injection decrease postoperative neck pain without increasing earlier instrument failure. CONCLUSIONS: Patients with ACP should undergo periodic prospective and cervical evaluations looking for impending cord compression. The optimal surgical approach (about routes, operative levels for stabilization) and immobilizations should be carefully considered preoperatively. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi: 10.1016/j.spinee.2010.07.220
178. Subsidence and Nonunion after Anterior Cervical Interbody Fusion with Stand-Alone Polyetheretherketone (PEEK) Cage Jae Jun Yang, MD1, Bong-Soon Chang, MD1, Jin Sup Yeom, MD1, Jae Hyup Lee, MD1, Chang Hun Yu, MD2, Choon-Ki Lee, MD1; 1 Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea; 2Department of Orthopedic Surgery, Gil Medical Center, Gacheon Medical University, In Cheon, Republic of Korea BACKGROUND CONTEXT: Subsidence and nonunion after anterior cervical discectomy and fusion (ACDF) using stand-alone intervertebral cage have been reported as the major complications of the procedure, and potential risk factors of the complications have been proposed in many studies. However, the clinical significance of the complications is confusing due to a broad range of the incidence rates and there have been few studies presenting the risk factors statistically evaluated. PURPOSE: To evaluate the incidence of subsidence and nonunion after ACDF and statistically analyze the risk factors. STUDY DESIGN/SETTING: A retrospective observational study on subsidence and nonunion after ACDF. PATIENT SAMPLE: Fifty-one consecutive patients (sixty-three segments) with degenerative cervical disc disease, who underwent anterior cervical fusion using stand-alone polyetheretherketone (PEEK) cage and autologous cancellous iliac bone graft, were retrospectively investigated. Thirty-eight patients (forty-seven segments) were enrolled in this study and exclusion criteria were a follow-up period less than twelve months, C7-T1 fusion (owing to the difficulty of the proper radiographic evaluation), previous anterior fusion in adjacent segments, and additional posterior decompression. OUTCOME MEASURES: Plain radiographs were examined for Anterior and posterior segmental height (ASH and PSH), the distance from the anterior edge of the upper vertebra to the anterior margin of the cage (cage distance), segmental lordosis, and nonunion defined based on the instability more than 2 mm in the interspinous distance on flexion-extension lateral radiographs. The risk factors of subsidence and nonunion were analyzed. METHODS: Subsidence was defined as more than 2 mm (minor) or 3 mm (major) decrease of ASH or PSH at the final follow-up compared to those measured at the immediate postoperative period. Patients with the subsidence more than 2 mm were defined as the subsidence group. The risk factors of the subsidence were evaluated through logistic regression analysis on potential risk factors including sex, AP diameter of a cage, cage distance, postoperative anterior distraction, and the increase of postoperative segmental lordosis. The risk factors of the nonunion were evaluated through univariate analysis comparing the nonunion group with the union group. RESULTS: ASH and PSH decreased from the immediate postoperative period to the final follow-up at 1.3361.46(mean6SD)mm and 0.8161.27 mm, respectively. The subsidence more than 2 mm and 3 mm were observed in twelve segments (12/47, 25.5%) and seven segments (7/47, 14.9%), respectively. The segmental lordosis decreased from the
All referenced figures and tables will be available at the Annual Meeting and will be included with the post-meeting online content.
Proceedings of the NASS 25th Annual Meeting / The Spine Journal 10 (2010) 1S–149S
METHODS: Reduction rates of opening angle and APD were calculated. On axial CT image at 6 M, and the fusion rate was evaluated by judging the hinge area as fusion or nonunion. Spinal cord compression was evaluated by 6 grade classification system (grade 0 to 5, 0:no compression, 1:subdural space compressed, 2:subdural space disappeared, 3:compression !1/4 of cord diameter, 4:compression 1/4-1/2 of cord diameter, 5:compression O1/2 of cord diameter) based on the MR sagittal images. RESULTS: Reduction rates of the AP diameter and the laminar angle were 9.4% and 10.2%, respectively, however, there was no significant difference from C3 to C7. The hinge was healed in 91% at 6 months. Immediate postoperative AP diameter and laminar angle did not correlate with the reduction rates (PO0.05). Severity of the cord compression on MR sagittal image improved from 2.961.3 degree to 1.461.0 degree postoperatively (P!0.0001). Nevertheless, the aggravation of spinal cord compression at the most stenotic level correlated with the decrease in the AP diameter and the laminar angle (P!0.05).There was a positive correlation between the APD and the laminar angle at 1 W and 6 M respectively (1 W; R50.645, P!0.0001, 6 M; R50.679, P!0.0001). Mean AP diameter was 8.461.8 mm preoperatively, which was increased immediately after surgery (14.563.0 mm) and decreased at 6 M significantly (13.163.0 mm) (P!0.0001). Mean laminar angle was 39.5613.6 at 1 W and reduced to 35.1612.3 at 6 M (P!0.0001). CONCLUSIONS: Reclosure of the opened lamina occurred in 10% of our patients during the 6 months following classic Hirabayashi open-door laminoplasty. Wider opening of the laminar does not prevent reclosure. Therefore, in order to prevent recurrent cord compression, other techniques, including the use of graft/spacer or tethering by suture anchor should be considered. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi: 10.1016/j.spinee.2010.07.219
177. Surgical Outcome of Cervical Spondylotic Myelopathy with Athetoid Cerebral Palsy Yoon Ha, MD, Seong Yi, Keungnyun Kim, MD, Do Heum Yoon, MD; Department of Neurosurgery, Yonsei University, Seoul, Republic of Korea BACKGROUND CONTEXT: Repetitive exaggerated neck movements in ACP may result in early degeneration of cervical spine requires operative managements. Moreover, these abnormal involuntary movements give rise to earlier instrument failure requires additional operative treatment and increase the incidence of recurrence of myelopathy. Understanding the outcome of operative management can aid in this decision-making process for the treatment of CSM in ACP. PURPOSE: To understand the mid to long-term follow-up surgical outcome including complications, and discuss the surgical strategy for operative treatment of CSM in ACP. STUDY DESIGN/SETTING: A retrospective analysis of medical record and radiographic findings of patients followed for more than one year after surgical treatment for cervical spondylotic myelopathy (CSM) associated with athetoid cerebral palsy (ACP). PATIENT SAMPLE: We retrospectively reviewed athetoid cerebral palsy 24 patients who underwent surgeries for CSM at our hospital from March 2002 to June 2008. Anterior fusion, posterior fusion or combined (anterior and posterior) surgeries were performed. Average follow-up duration is 26.4 months. OUTCOME MEASURES: JOA scores, Neck disability index, visual analogue scale. METHODS: Surgical outcome, as assessed by JOA scores, NDI (neck disability index) and visual analogue scale (VAS) were compared between preoperative and postoperative state. RESULTS: Anterior fusion was performed in 11 patients and posterior fusion was done in 1 patient. C1/2 posterior screw fixation was performed in 5 patients and combined approach (anterior and posterior fusion) was done
in 7 patients. According to JOA scores, patients showed postoperative improvement (7.26 to 10.79). NDI was decreasing from 64.94 to 41.76%. Revision surgery was in 7 cases, due to instrument failure related with progressive kphotic deformity after first surgery. Preoperative botulinum toxin injection decrease postoperative neck pain without increasing earlier instrument failure. CONCLUSIONS: Patients with ACP should undergo periodic prospective and cervical evaluations looking for impending cord compression. The optimal surgical approach (about routes, operative levels for stabilization) and immobilizations should be carefully considered preoperatively. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi: 10.1016/j.spinee.2010.07.220
178. Subsidence and Nonunion after Anterior Cervical Interbody Fusion with Stand-Alone Polyetheretherketone (PEEK) Cage Jae Jun Yang, MD1, Bong-Soon Chang, MD1, Jin Sup Yeom, MD1, Jae Hyup Lee, MD1, Chang Hun Yu, MD2, Choon-Ki Lee, MD1; 1 Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea; 2Department of Orthopedic Surgery, Gil Medical Center, Gacheon Medical University, In Cheon, Republic of Korea BACKGROUND CONTEXT: Subsidence and nonunion after anterior cervical discectomy and fusion (ACDF) using stand-alone intervertebral cage have been reported as the major complications of the procedure, and potential risk factors of the complications have been proposed in many studies. However, the clinical significance of the complications is confusing due to a broad range of the incidence rates and there have been few studies presenting the risk factors statistically evaluated. PURPOSE: To evaluate the incidence of subsidence and nonunion after ACDF and statistically analyze the risk factors. STUDY DESIGN/SETTING: A retrospective observational study on subsidence and nonunion after ACDF. PATIENT SAMPLE: Fifty-one consecutive patients (sixty-three segments) with degenerative cervical disc disease, who underwent anterior cervical fusion using stand-alone polyetheretherketone (PEEK) cage and autologous cancellous iliac bone graft, were retrospectively investigated. Thirty-eight patients (forty-seven segments) were enrolled in this study and exclusion criteria were a follow-up period less than twelve months, C7-T1 fusion (owing to the difficulty of the proper radiographic evaluation), previous anterior fusion in adjacent segments, and additional posterior decompression. OUTCOME MEASURES: Plain radiographs were examined for Anterior and posterior segmental height (ASH and PSH), the distance from the anterior edge of the upper vertebra to the anterior margin of the cage (cage distance), segmental lordosis, and nonunion defined based on the instability more than 2 mm in the interspinous distance on flexion-extension lateral radiographs. The risk factors of subsidence and nonunion were analyzed. METHODS: Subsidence was defined as more than 2 mm (minor) or 3 mm (major) decrease of ASH or PSH at the final follow-up compared to those measured at the immediate postoperative period. Patients with the subsidence more than 2 mm were defined as the subsidence group. The risk factors of the subsidence were evaluated through logistic regression analysis on potential risk factors including sex, AP diameter of a cage, cage distance, postoperative anterior distraction, and the increase of postoperative segmental lordosis. The risk factors of the nonunion were evaluated through univariate analysis comparing the nonunion group with the union group. RESULTS: ASH and PSH decreased from the immediate postoperative period to the final follow-up at 1.3361.46(mean6SD)mm and 0.8161.27 mm, respectively. The subsidence more than 2 mm and 3 mm were observed in twelve segments (12/47, 25.5%) and seven segments (7/47, 14.9%), respectively. The segmental lordosis decreased from the
All referenced figures and tables will be available at the Annual Meeting and will be included with the post-meeting online content.