In only one session I was able to locate the following abstracts of
published articles that seem to relate cervical stenosis to cerebral
palsy as a "Secondary Condition" that might be expected to occur in
all cerebral palsy cases with the more severe spastic cases
experiencing earlier onset of cervical stenosis.
I am sorry that I don't have the time or the resources to get the
original articles but I have included the original sources to help
you follow up any articles that interest you. (After your librarian
says that even Interlibrary Loan can't find a copy of the article,
you will begin to appreciate the difficulty in this type of research.
In an ideal world all knowledge would be available to all researchers,
but in reality, if you don't have Big Bucks, Cerebral Palsy is not
your biggest handicap.
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Movement Disorders - official publication of the Movement Disorder Society
ISSN 0885-3185
1998 Jul;13(4):713-7
Comment in:
Mov Disord. 1999 Jan;14(1):194-5.
Neurosurgical intervention for cervical disk disease in dystonic cerebral
palsy.
Pollak L, Schiffer J, Klein C, Mirovsky Y, Copeliovich L, Rabey JM.
Department of Neurology, Assaf Harofeh Medical Center, Zerifin, Israel.
We report five young patients with athetoid-spastic cerebral palsy who had
deteriorated neurologically. Magnetic resonance imaging (MRI) was used to
investigate suspected compressive cervical spine lesion. Cervical spondylosis
with disk protrusions was found in all patients. Four patients underwent
surgery by an anterior approach with insertion of a bone graft resulting in
substantial clinical improvement. The other patient, diagnosed 8 years after
onset of symptoms, was treated conservatively. The availability of MRI makes
early recognition of cervical cord compression possible, allowing effective
surgical intervention in this special group of patients.
PMID: 9686780 [PubMed - indexed for MEDLINE]
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Journal of bone and joint surgery - British volume
ISSN 0301-620X
1996 Jul:78(4):613-9
The cervical spine in athetoid cerebral palsy. A radiological study of 180
patients.
Harada T, Ebara S, Anwar MM, Okawa A, Kajiura I, Hiroshima K, Ono K.
Osaka Police Hospital, Japan.
We have reviewed the cervical spine radiographs of 180 patients with athetoid
cerebral palsy and compared them with those of 417 control subjects. Disc
degeneration occurred earlier and progressed more rapidly in the patients, with
advanced disc degeneration in 51%, eight times the frequency in normal subjects.
At the C3/4 and C4/5 levels, there was listhetic instability in 17% and 27% of
the patients, respectively, again six and eight times more frequently than in
the control subjects. Angular instability was seen, particularly at the C3/4,
C4/5 and C5/6 levels. We found a significantly higher incidence of narrowing of
the cervical canal in the patients, notably at the C4 and C5 levels, where the
average was 14.4 mm in the patients and 16.4 mm in normal subjects. The
combination of disc degeneration and listhetic instability with a narrow canal
predisposes these patients to relatively rapid progression to a devastating
neurological deficit.
PMID: 8682830 [PubMed - indexed for MEDLINE]
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Spinal Cord 1998 Apr;36(4):288-92
Spinal cord injury secondary to cervical disc herniation in ambulatory
patients with cerebral palsy.
Ko HY, Park-Ko I.
Department of Rehabilitation Medicine, Pusam National University Hospital, Pusan
National University College of Medicine, Korea.
Early onset of degeneration of the cervical spine and instability due to
sustained abnormal tonicity or abnormal movement of the neck are found in
patients with cerebral palsy. An unexplained change or deterioration of
neurological function in patients with cerebral palsy should merit the
consideration of the possibility of cervical myelopathy due to early
degeneration or instability of the cervical spine. We describe two patients
who had a spinal cord injury due to a cervical disc herniation, one patient
was athetoid and the second had spastic diplegia, they both had cerebral
palsy. It is not easy to determine whether new neurological symptoms are
as a result of the cervical spinal cord disorder. These cases suggest that
consideration of a cervical spine disorder with myelopathy is required in
the evaluation of patients with cerebral palsy who develop deterioration of
neurological function or activities over a short period of time.
PMID: 9589531 [PubMed - indexed for MEDLINE]
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Dev Med Child Neurol 1991 Feb;33(2):153-8
Acquired cervical spine impairment in young adults with cerebral palsy.
Reese ME, Msall ME, Owen S, Pictor SP, Paroski MW.
State University of New York, Buffalo.
Three patients with spastic cerebral palsy and no associated movement
disorder--each of whom presented with loss of functional skills and delay
in the definitive diagnosis of cervical myelopathy--are reported, in order
to increase awareness of the possibility of cervical spine pathology in
these adults. The possibility of myelopathy should be investigated when
considering the etiology of functional deterioration. A functional
neurological examination for all multiply disabled individuals is proposed
as a reference for future comparison.
PMID: 2015983 [PubMed - indexed for MEDLINE]
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Arch Orthop Trauma Surg 1997;116(1-2):116-8
Cervical myelo-radiculopathy in athetoid cerebral palsy.
Mikawa Y, Watanabe R, Shikata J.
Department of Orthopaedic Surgery, Kawasaki Medical School, Okayama, Japan.
Cervical myelopathy complicating athetoid cerebral palsy has not been adequately
highlighted in the literature. We report two cases of patients with athetoid
cerebral palsy and long histories of involuntary movements who developed cervical
myelo-radiculopathy. Dystonic athetoid neck movements may cause excessive axial
neck rotation as well as flexion and extension movements of the spine. These
repetitive exaggerated movements may result in early degenerative changes of the
vertebrae which may enhance the myelo-radiculopathy. The two patients were
treated with combined anterior and posterior fusion with satisfactory results.
They were bedridden preoperatively but have since started walking with or without
a cane. We conclude that combined anterior and posterior fusion is the treatment
of choice for severe myelopathy complicating athetoid cerebral palsy.
PMID: 9006780 [PubMed - indexed for MEDLINE]
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Rinsho Shinkeigaku 1993 Feb;33(2):121-9
[Clinical and pathological study of myelopathy accompanied with cervical
spinal canal stenosis--with special reference to complication of mental
retardation or cerebral palsy]
[Article in Japanese]
Nokura K, Hashizume Y, Inagaki T, Ojika K, Yamamoto M.
Department of Internal Medicine, Nagoya-shi Koseiin Geriatric Hospital, Japan.
We studied 3 cases with myelopathy caused by cervical spinal canal stenosis
(developmental), who had been suffering from walking difficulty followed by
tetraplegia, clinically and pathologically. In all 3 cases, mental retardation
and/or cerebral palsy was diagnosed. We hypothesized that the brain damage in
the developmental stage might also cause developmental disturbance in the
cervical spine. In all cases, pathological investigation showed decreased
antero-posterior diameter and degeneration in the gray matter and in the
lateral and posterior column in the involved cervical spinal cord. The
findings, such as relative preservation of the anterior column and cyst
formation in the gray matter, were thought to be in common with cervical
spondylotic myelopathy or ossification of the occipital longitudinal ligament
(OPLL) which had been reported before. In one case we found aberrant peripheral
nerve bundles and peripheral type remyelination in the transverse spinal cord
lesion. Compared to the pathological change in the OPLL, our cases showed more
severe degenerative change in the spinal segments with a relatively preserved
antero-posterior diameter of the spinal cord, which supports the theory that
the dynamic factor plays a more important role than the static compression
factor. We concluded that the aging process and/or dystonic neck movement
added spondylotic change to the narrow canal, and excess movement of the neck
and/or falls caused dynamic injury to the spinal cord and secondary circulatory
disturbance further worsened spinal lesions. When elderly patients with cerebral
palsy develop motor symptoms, we should consider cervical spinal stenosis as a
possible cause.
PMID: 8319381 [PubMed - indexed for MEDLINE]
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J Orthop Sci 2000;5(5):439-48
Surgical treatment for cervical spondylotic myelopathy associated with
athetoid cerebral palsy.
Onari K.
Department of Orthopedic Surgery, Yokohama Minami Kyosai Hospital, 500 Mutsuura,
Kanazawa-ku, Yokohama, Kanagawa 236-0032, Japan.
There have been several reports on surgical interventions in patients with adult
cervical spondylotic myelopathy associated with athetoid cerebral palsy; however,
the long-term effectiveness of these interventions has not been demonstrated. We
have performed surgical treatments--posterior fusion with wave-shaped rods and
anterior interbody fusion with internal fixators-- in 20 patients. The present
study included 17 of these patients, 16 men and 1 woman, and their mean follow-up
period was 8.6 years (range, 5-15.5 years). One year after surgery, walking ability
was improved in 14 patients. Pain in the upper extremities and muscle weakness of
the deltoid were alleviated in all patients. One patient showed recurrence of
myelopathy after 8.5 years' follow-up. Our surgical technique is effective in
patients with cervical spondylotic myelopathy secondary to athetoid cerebral palsy,
even in those with severe involuntary movements. Postoperative rigid external
fixations are not required.
PMID: 11180900 [PubMed - indexed for MEDLINE]
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Eur Neurol 1987;27(3):164-6
Late-onset progressive radiculomyelopathy in patients with cervical
athetoid-dystonic cerebral palsy.
Kidron D, Steiner I, Melamed E.
Three patients with severe athetoid-dystonic type of cerebral palsy involving the
neck musculature developed in their fourth to fifth decade progressive cervical
radiculomyelopathy associated with vertebral spondylarthrotic compressive lesions
in addition to their long-standing neurological syndrome. It is likely that the
late-onset myelopathy is linked to continuous torsion, compression and 'wear and
tear' of the cervical spinal cord, induced by the involuntary movements. In 2
patients decompressive cervical spinal surgery was ineffective, suggesting
irreversible damage.
PMID: 3622589 [PubMed - indexed for MEDLINE]
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Surg Neurol 1999 Oct;52(4):339-44
Circumferential cervical surgery for spondylostenosis with kyphosis in two
patients with athetoid cerebral palsy.
Epstein NE.
Department of Surgery (Neurosurgery), North Shore University Hospital,
Manhasset, NY, USA.
BACKGROUND: Patients with athetoid cerebral palsy may develop severe degenerative
changes in the cervical spine decades earlier than their normal counterparts due
to abnormal cervical motion. METHODS: Two patients, 48 and 52 years of age,
presented with moderate to severe myelopathy (Nurick Grades IV and V). MR and
3-dimensional CT studies demonstrated severe spondylostenosis with kyphosis in
both patients. This necessitated multilevel anterior corpectomy with fusion
(C2-C7, C3-C7) using fibula and iliac crest autograft and Orion plating, followed
by posterior wiring, fusion using Songer cables, and halo placement. RESULTS:
Postoperatively, both patients improved, demonstrating only mild or mild to
moderate (Nurick Grades II and III) residual myelopathy. Although both fused
posteriorly within 3.5 months, the patient with the fibula graft developed a
fracture of the anterior C7 body with mild anterior graft migration, and inferior
plate extrusion into the C7-T1 interspace. However, because he has remained
asymptomatic for 9 months postoperatively, without dysphagia, removal of the plate
has not yet been necessary. CONCLUSIONS: Patients with athetoid cerebral palsy
should undergo early prospective cervical evaluations looking for impending cord
compromise. When surgery is indicated, circumferential surgery offers the maximal
degree of cord decompression and stabilization with the highest rate of fusion.
PMID: 10555838 [PubMed - indexed for MEDLINE]
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