T-SAW LAMINOPLASTY AND PEDICLE SCREW FIXATION WITH CERVICAL KYPHOSIS IN ATETOID CEREBRAL PALSY

Introduction Correction and arthrodesis for cervical kyphosis associated with atetoid cerebral palsy has been considered to be difficult because of their involuntary neck movements and severe deformity. The aim of this study is to evaluate the surgical outcome of midline T-saw laminoplasty and posterior arthrodesis using pedicle screws. Methods 15 patients were retrospectively reviewed. There were 6 women and 9 men, with a mean age 52.9 years (range 31–71 years). Mean follow-up period was 43 months (range 24–84 months). For clinical evaluation, the Japanese Orthopaedic Association (JOA) score and Barthel index (BI) which shows independence in ADL were used. For radiographic evaluation, change of C2–C7 Cobb angle of sagittal alignment, adjacent segment instability after the surgery were evaluated. Results The average JOA score improved significantly from 6.2 preoperatively to 10.5 postoperatively. The average BI improved from 44.2 before surgery to 72.5 after surgery. C2–C7 Cobb angle of sagittal alignment measured 12.3 degrees of kyphosis preoperatively and 1.2 degrees of lordosis postoperatively. Solid posterior bony fusion was achieved in all cases. There was two cases of adjacent segmental instability, which required additional surgery. Seven (5.6%) out of the 125 inserted screws showed more than 2mm deviation. However, there were no neurovascular complications during or after surgery in any cases, and all cases maintained strong internal fixation. Conclusion Midline T-saw laminoplasty and posterior arthrodesis using pedicle screw is a favorable option for the patient with kyphotic deformity associated with atetoid cerebral palsy, as it preserves cervical alignment, and improve neurological status and ADL.