ORIGINAL ARTICLE Treatment Strategy for Cervical Myelopathy in Patients with Athetoid Cerebral Palsy Hiroshi Kuroki, Shinichiro Kubo, Hideaki Hamanaka, Naoki Inomata, Kiyoshi Higa, Etsuo Chosa 243 Int Journal of Orthopaedics 2015 April 23 2(2): 243-249 ISSN 2311-5106 (Print), ISSN 2313-1462 (Online) Online Submissions: http://www.ghrnet.org/index./ijo/ doi:10.6051/j.issn.2311-5106.2015.02.60 © 2015 ACT. All rights reserved. International Journal of Orthopaedics Hiroshi Kuroki, Department of Orthopaedic Surgery, National Hos- pital Organization Miyazaki Higashi Hospital, Japan Shinichiro Kubo, Department of Orthopaedic Surgery, Nozaki Hi- gashi Hospital, Japan Hideaki Hamanaka, Naoki Inomata, Kiyoshi Higa, Etsuo Chosa, Department of Orthopaedic Surgery, University of Miyazaki Faculty of Medicine, Japan Correspondence to: Hiroshi Kuroki, MD, Department of Ortho- paedic Surgery, National Hospital Organization Miyazaki Higashi Hospital, 4374-1 Tayoshi Ooaza Miyazaki, 880-0911 Japan. Email: hiroshik@med.miyazaki-u.ac.jp Telephone: +81-985-56-2311 Fax: + 81-985-56-2257 Received: December 6, 2014 Revised: January 5, 2015 Accepted: January 11, 2015 Published online: April 23, 2015 ABSTRACT AIM: In athetoid cerebral palsy (ACP) patients, severe and progressive cervical myelopathy (CM) often develops at a young age for the reason that involuntary movement due to ACP facilitates degeneration of cervical spine. The purpose of this retrospective study was to explore the optimal management of CM due to ACP. MATERIALS AND METHODS: From 2004 through 2013, 16 consecutive cases of CM in ACP who were surgically treated were studied. They included 7 males and 9 females with a mean age of 55 years. Mean duration of postoperative follow-up was 3 years and 6 months. We clinically and radiographically evaluated in these cases. RESULTS: Posterior decompression and fusion was employed in 10 cases, posterior fusion in 4 cases, and laminoplasty in 2 cases. In 13 cases, botulinum toxin injection, selective muscle release, or both were additionally performed. As to clinical outcome evaluated by Fuji’s scale, 4 cases had excellent, 8 cases had good, 3 cases had fair, and 1 case had poor results. Perioperative complication was observed in 8 cases. Lordosis of cervical spine increased in 6 cases, decreased in 4 cases, and unchanged in 6 cases after surgery. Bone union was obtained in all 14 cases who were performed fusion surgery. CONCLUSIONS: For the treatment of CM in ACP, evaluations of the intensity and the pattern of athetoid movement are important features for selection of the proper surgical method. Strong cervical fixation accompanied with various athetoid movement control procedures to achieve solid bone union may warrant long-term acceptable clinical results. © 2015 ACT. All rights reserved. Key words: Athetoid cerebral palsy; Cervical myelopathy; Spinal instrumentation; Surgical treatment; Botulinum toxin Kuroki H, Kubo S, Hamanaka H, Inomata N, Higa K, Chosa E. Treatment Strategy for Cervical Myelopathy in Patients with Athetoid Cerebral Palsy. International Journal of Orthopaedics 2015; 2(2): 243-249 Available from: URL: http://www.ghrnet.org/index.php/ijo/ article/view/949 INTRODUCTION In athetoid cerebral palsy (ACP) patients, severe and progressive cervical myelopathy (CM) often develops at a younger age for the reason that involuntary cervical movement accelerates disc degeneration of the cervical spine [1-3] . However, the diagnosis is frequently overlooked due to the insidious progression of neurologic disorders and the pre-existent neurological handicap [1] . Because the conservative treatment is not effective, the surgical treatment must be required in most of the patients [4] . Whereas, the pathophysiology of this disorder is complex and multifactorial, therefore the standard surgical strategies have not been established yet. In principle, we usually decide the surgical method on the basis of both the physical status and the intensity of athetoid movement in each patient. The purpose of the current study was to investigate the clinical and radiographical results of surgical treatments for 16 patients suffering from CM in ACP.