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Yang JJ, Choi JY, Lee DH, Hwang CJ, Cho JH, Park S. Reoperation Rates According to Surgical Approach After Operation for Degenerative Cervical Pathology in Patients With Athetoid Cerebral Palsy: A Nationwide Cohort Study. Global Spine J 2024:21925682241247486. [PMID: 38631333 DOI: 10.1177/21925682241247486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024] Open
Abstract
STUDY DESIGN National population-based cohort study. OBJECTIVE The overall complication rate for patients with athetoid cerebral palsy (CP) undergoing cervical surgery is significantly higher than that of patients without CP. The study was conducted to compare the reoperation and complication rates of anterior fusion, posterior fusion, combined fusion, and laminoplasty for degenerative cervical myelopathy/radiculopathy in patients with athetoid cerebral palsy. METHODS The Korean Health Insurance Review and Assessment Service national database was used for analysis. Data from patients diagnosed with athetoid CP who underwent cervical spine operations for degenerative causes between 2002 and 2020 were reviewed. Patients were categorized into four groups for comparison: anterior fusion, posterior fusion, combined fusion, and laminoplasty. RESULTS A total of 672 patients were included in the study. The overall revision rate was 21.0% (141/672). The revision rate was highest in the anterior fusion group (42.7%). The revision rates of combined fusion (11.1%; hazard ratio [HR], .335; P = .002), posterior fusion (13.8%; HR, .533; P = .030) were significantly lower than that of anterior fusion. Revision rate of laminoplasty (13.1%; HR, .541; P = .240) was also lower than anterior fusion although the result did not demonstrate statistical significance. CONCLUSION Anterior fusion presented the highest reoperation risk after cervical spine surgery reaching 42.7% in patients with athetoid CP. Therefore, anterior-only fusion in patients with athetoid CP should be avoided or reserved for strictly selected patients. Combined fusion, with the lowest revision risk at 11.1%, could be safely applied to patients with athetoid CP.
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Affiliation(s)
- Jae Jun Yang
- Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Goyangsi, Republic of Korea
| | - Jun Young Choi
- Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Goyangsi, Republic of Korea
| | - Dong-Ho Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chang Ju Hwang
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Hwan Cho
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sehan Park
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Tachibana N, Michihata N, Oichi T, Nagata K, Nakamoto H, Ohtomo N, Yoshida Y, Nakajima K, Miyahara J, Kato S, Doi T, Taniguchi Y, Matsubayashi Y, Tanaka S, Yasunaga H, Oshima Y. Postoperative Complications of Surgery for Cervical Spondylotic Myelopathy with and Without Athetoid Cerebral Palsy. Global Spine J 2024:21925682241239610. [PMID: 38468399 DOI: 10.1177/21925682241239610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/13/2024] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES With the aging of the Japanese population, patients with athetoid cerebral palsy (ACP) are getting older, and the rate of surgery for CSM is increasing in ACP patients. However, postoperative complications of such surgery among adult patients with ACP have not been reported yet. We investigated postoperative complications of surgery for CSM with ACP and compared them with those of surgery for CSM without ACP using a national inpatient database of Japan. METHODS Using the Diagnosis Procedure Combination database, we identified 61382 patients who underwent surgery for CSM from July 2010 to March 2018. We examined patient backgrounds, surgical procedures, and type of hospital, and a 4:1 propensity score matching was performed to compare the outcomes between the non-ACP and ACP groups. RESULTS There were 60 847 patients without ACP and 535 patients with ACP. The mean age was 68.5 years in the non-ACP group and 55 years in the ACP group. The percentages of patients who underwent fusion surgery were 21.6% and 68.8% in the non-ACP and ACP groups, respectively. The 4:1 propensity score matching selected 1858 in the non-ACP group and 465 in the ACP group. The ACP group was more likely to have postoperative urinary tract infection (.4% vs 2.8%, P < .001), postoperative pneumonia (.4% vs 2.4%, P < .001), and 90-day readmission for reoperation (1.9% vs 4.3%, P = .003). CONCLUSIONS We found that ACP patients were more vulnerable to postoperative complications and reoperation after CSM than non-ACP patients.
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Affiliation(s)
- Naohiro Tachibana
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Japan
| | - Nobuaki Michihata
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Japan
| | - Takeshi Oichi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Japan
| | - Kosei Nagata
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Japan
| | - Hideki Nakamoto
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Japan
| | - Nozomu Ohtomo
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Japan
| | - Yuichi Yoshida
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Japan
| | - Koji Nakajima
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Japan
| | - Junya Miyahara
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Japan
| | - So Kato
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Japan
| | - Toru Doi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Japan
| | - Yuki Taniguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Japan
| | | | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Japan
| | - Yasushi Oshima
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Japan
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Zech M, Lam DD, Weber S, Berutti R, Poláková K, Havránková P, Fečíková A, Strom TM, Růžička E, Jech R, Winkelmann J. A unique de novo gain-of-function variant in CAMK4 associated with intellectual disability and hyperkinetic movement disorder. Cold Spring Harb Mol Case Stud 2018; 4:mcs.a003293. [PMID: 30262571 PMCID: PMC6318768 DOI: 10.1101/mcs.a003293] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 09/04/2018] [Indexed: 01/12/2023] Open
Abstract
Calcium/calmodulin-dependent protein kinases (CaMKs) are key mediators of calcium signaling and underpin neuronal health. Although widely studied, the contribution of CaMKs to Mendelian disease is rather enigmatic. Here, we describe an unusual neurodevelopmental phenotype, characterized by milestone delay, intellectual disability, autism, ataxia, and mixed hyperkinetic movement disorder including severe generalized dystonia, in a proband who remained etiologically undiagnosed despite exhaustive testing. We performed trio whole-exome sequencing to identify a de novo essential splice-site variant (c.981+1G>A) in CAMK4, encoding CaMKIV. Through in silico evaluation and cDNA analyses, we demonstrated that c.981+1G>A alters CAMK4 pre-mRNA processing and results in a stable mRNA transcript containing a 77-nt out-of-frame deletion and a premature termination codon within the last exon. The expected protein, p.Lys303Serfs*28, exhibits selective loss of the carboxy-terminal regulatory domain of CaMKIV and bears striking structural resemblance to previously reported synthetic mutants that confer constitutive CaMKIV activity. Biochemical studies in proband-derived cells confirmed an activating effect of c.981+1G>A and indicated that variant-induced excessive CaMKIV signaling is sensitive to pharmacological manipulation. Additionally, we found that variants predicted to cause selective depletion of CaMKIV's regulatory domain are unobserved in diverse catalogs of human variation, thus revealing that c.981+1G>A is a unique molecular event. We propose that our proband's phenotype is explainable by a dominant CAMK4 splice-disrupting mutation that acts through a gain-of-function mechanism. Our findings highlight the importance of CAMK4 in human neurodevelopment, provide a foundation for future clinical research of CAMK4, and suggest the CaMKIV signaling pathway as a potential drug target in neurological disease.
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Affiliation(s)
- Michael Zech
- Institut für Neurogenomik, Helmholtz Zentrum München, Munich, 85764, Germany.,Klinik und Poliklinik für Neurologie, Klinikum rechts der Isar, Technische Universität München, Munich, 81675, Germany
| | - Daniel D Lam
- Institut für Neurogenomik, Helmholtz Zentrum München, Munich, 85764, Germany
| | - Sandrina Weber
- Institut für Neurogenomik, Helmholtz Zentrum München, Munich, 85764, Germany
| | - Riccardo Berutti
- Institut für Humangenetik, Helmholtz Zentrum München, Munich, 85764, Germany
| | - Kamila Poláková
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General Faculty Hospital, Prague, 120 00, Czech Republic
| | - Petra Havránková
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General Faculty Hospital, Prague, 120 00, Czech Republic
| | - Anna Fečíková
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General Faculty Hospital, Prague, 120 00, Czech Republic
| | - Tim M Strom
- Institut für Humangenetik, Helmholtz Zentrum München, Munich, 85764, Germany.,Institut für Humangenetik, Technische Universität München, Munich, 81675, Germany
| | - Evžen Růžička
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General Faculty Hospital, Prague, 120 00, Czech Republic
| | - Robert Jech
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General Faculty Hospital, Prague, 120 00, Czech Republic
| | - Juliane Winkelmann
- Institut für Neurogenomik, Helmholtz Zentrum München, Munich, 85764, Germany.,Institut für Humangenetik, Technische Universität München, Munich, 81675, Germany.,Lehrstuhl für Neurogenetik, Technische Universität München, Munich, 80333, Germany.,Munich Cluster for Systems Neurology, SyNergy, Munich, 81377, Germany
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Takei YI, Koshihara H, Oguchi K, Oyanagi K, Ohara S. An Autopsy Case of Respiratory Failure Induced by Repetitive Cervical Spinal Cord Damage due to Abnormal Movement of the Neck in Athetoid Cerebral Palsy. Intern Med 2017; 56:1425-1430. [PMID: 28566610 PMCID: PMC5498211 DOI: 10.2169/internalmedicine.56.7411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
We herein report the clinical and autopsy findings of a 48-year-old right-handed man with athetoid cerebral palsy who suffered from cervical myelopathy due to abnormal neck movement, and who died of respiratory failure. Pathologically, the external appearance of the ventral surface of the cervical spinal cord revealed a linear indentation running obliquely at the level between the C4 and C5 segments. In the most severely compressed lesion, the gray matter was predominantly affected and severely atrophic. Microscopically, clusters of oligodendrocytes associated with thinly myelinated axons were also observed in the lateral funiculus. The latter findings are unique, and could be interpreted as regenerative and/or restorative phenomena of the central nervous system following chronic repetitive spinal cord compression.
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Affiliation(s)
- Yo-Ichi Takei
- Department of Neurology, NHO Matsumoto Medical Center, Chushin-Matsumoto Hospital, Japan
| | - Hiroshi Koshihara
- Department of Neurology, NHO Matsumoto Medical Center, Chushin-Matsumoto Hospital, Japan
| | - Kenya Oguchi
- Department of Neurology, NHO Matsumoto Medical Center, Chushin-Matsumoto Hospital, Japan
| | - Kiyomitsu Oyanagi
- Division of Neuropathology, Department of Brain Disease Research, Shinshu University School of Medicine, Japan
| | - Shinji Ohara
- Department of Neurology, NHO Matsumoto Medical Center, Chushin-Matsumoto Hospital, Japan
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Zhou H, Liu ZJ, Wang SB, Pan SF, Yan M, Zhang FS, Sun Y. Laminoplasty with lateral mass screw fixation for cervical spondylotic myelopathy in patients with athetoid cerebral palsy: A retrospective study. Medicine (Baltimore) 2016; 95:e5033. [PMID: 27684879 PMCID: PMC5265972 DOI: 10.1097/md.0000000000005033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Although several studies report various treatment solutions for cervical spondylotic myelopathy in patients with athetoid cerebral palsy, long-term follow-up studies are very rare. None of the reported treatment solutions represent a gold standard for this disease owing to the small number of cases and lack of long-term follow-up. This study aimed to evaluate the outcomes of laminoplasty with lateral mass screw fixation to treat cervical spondylotic myelopathy in patients with athetoid cerebral palsy from a single center.This retrospective study included 15 patients (9 male patients and 6 female patients) with athetoid cerebral palsy who underwent laminoplasty with lateral mass screw fixation for cervical spondylotic myelopathy at our hospital between March 2006 and June 2010. Demographic variables, radiographic parameters, and pre- and postoperative clinical outcomes determined by the modified Japanese Orthopedic Association (JOA), Neck Disability Index (NDI), and visual analog scale (VAS) scores were assessed.The mean follow-up time was 80.5 months. Developmental cervical spinal canal stenosis (P = 0.02) and cervical lordosis (P = 0.04) were significantly correlated with lower preoperative modified JOA scores. The mean modified JOA scores increased from 7.97 preoperatively to 12.1 postoperatively (P < 0.01). The mean VAS score decreased from 5.30 to 3.13 (P < 0.01), and the mean NDI score decreased from 31.73 to 19.93 (P < 0.01). There was a significant negative correlation between developmental cervical spinal canal stenosis and recovery rate of the modified JOA score (P = 0.01).Developmental cervical spinal canal stenosis is significantly related to neurological function in patients with athetoid cerebral palsy. Laminoplasty with lateral mass screw fixation is an effective treatment for cervical spondylotic myelopathy in patients with athetoid cerebral palsy and developmental cervical spinal canal stenosis.
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Affiliation(s)
- Hua Zhou
- Department of Orthopaedics, Peking University Third Hospital
- Beijing Key Laboratory of Spinal Diseases, Beijing, China
| | - Zhong-jun Liu
- Department of Orthopaedics, Peking University Third Hospital
- Beijing Key Laboratory of Spinal Diseases, Beijing, China
- Correspondence: Yu Sun, Department of Orthopaedics, Peking University Third Hospital, No. 49 Huayuanbei Road, Haidian District, Beijing 100191, China (e-mail: ); Zhong-jun Liu, Department of Orthopaedics, Peking University Third Hospital, No. 49 Huayuanbei Road, Haidian District, Beijing 100191, China (e-mail: )
| | - Shao-bo Wang
- Department of Orthopaedics, Peking University Third Hospital
- Beijing Key Laboratory of Spinal Diseases, Beijing, China
| | - Sheng-fa Pan
- Department of Orthopaedics, Peking University Third Hospital
- Beijing Key Laboratory of Spinal Diseases, Beijing, China
| | - Ming Yan
- Department of Orthopaedics, Peking University Third Hospital
- Beijing Key Laboratory of Spinal Diseases, Beijing, China
| | - Feng-shan Zhang
- Department of Orthopaedics, Peking University Third Hospital
- Beijing Key Laboratory of Spinal Diseases, Beijing, China
| | - Yu Sun
- Department of Orthopaedics, Peking University Third Hospital
- Beijing Key Laboratory of Spinal Diseases, Beijing, China
- Correspondence: Yu Sun, Department of Orthopaedics, Peking University Third Hospital, No. 49 Huayuanbei Road, Haidian District, Beijing 100191, China (e-mail: ); Zhong-jun Liu, Department of Orthopaedics, Peking University Third Hospital, No. 49 Huayuanbei Road, Haidian District, Beijing 100191, China (e-mail: )
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