Untitled Document

Cervical spine stenosis in seven patients with spastic dystonic cerebral palsy

D KANTER MD, L LOGAN MASTERS OF PT, M TURK MD

Physical Medicine and Rehabilitation, SUNY Upstate Medical University, Syracuse, NY, USA

Background/Objectives: Illustrate the importance of evaluating any change in function in patients with spastic dystonic cerebral palsy, and consideration of cervical stenosis as the cause when clinically indicated.

Design: Case series

Participants and Setting: Seven subjects with bilateral spastic cerebral palsy (CP), two with dystonia only, ages 36 to 59 years old in a tertiary care hospital.

Materials/Methods: All subjects presented with history of progressive loss of function, most over a period of years. All complained of worsening mobility, often associated with falls. On average, subjects’ severity increased by one level on the GMFCS scale. Five had change in bladder function, and two had changes in bowel function. Six of seven had a significant increase in their tone. Two had new complaints of dysphagia. All subjects noted a decrease in function necessitating more help with activities of daily living (ADL’s). All subjects had their cervical spine imaged by MRI. All showed evidence of central canal stenosis and four of seven showed evidence of damage to the spinal cord. Of those four, two had spasticity and dystonia, one had spasticity only, and one had dystonia only. All seven were referred to a spine surgeon.

Results: All seven subjects underwent cervical decompression and spinal fusion, with one undergoing a second surgery six years later (total 8 surgeries). Postg operatively six of seven subjects participated in an inpatient comprehensive rehabilitation program. Six of eight surgeries resulted in improvements in tone and function during rehabilitation. The other two produced no improvements in symptoms but there has been no further progression. These two surgeries were associated with MRI evidence of cord edema and both subjects have primarily dystonia; one of these represents the repeated surgery. Three months following the cervical decompression all subjects showed some improvement in tone and function. Two returned to their previous level of function on the GMFCS scale. The subjects who had noted bowel and bladder incontinence showed improvement. All subjects remain stable years later with no appreciable decrease in function.

Conclusions/Significance: Changes in neurologic signs and symptoms from cervical stenosis in people with CP are often overlooked, or downplayed, and believed to be “progression” of their CP. The neurologic changes that occur with worsening cervical stenosis can be debilitating, but they may be preventable or ameliorated with proper recognition and treatment. The smallest improvements were seen in those with dystonia, who also had evidence of cord edema on MRI. This series notes stenosis can be seen in those with spastic as well as dystonic CP, at no common cervical level, and at GMFCS levels I-III. New neurologic findings or changes in function in people with CP must be fully investigated and cannot be explained as progression of their CP. Even minor changes noted on scans can result in functional changes in those with already existing impairments in motor control.

 
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