STUDY DESIGN: Observational cohort study. PURPOSE: To assess the surgical outcomes of posterior decompression and fusion for cervical myelopathy in patients with athetoid cerebral palsy. OVERVIEW OF LITERATURE: Patients with athetoid cerebral palsy demonstrate involuntary movements and develop severe cervical spondylosis with kyphosis. In these patients, surgery is often performed at an early age because of myelopathy. A few studies have reported about the long-term outcomes of surgical treatment; however, they contain insufficient information. METHODS: From 2003 to 2008, 13 patients with cervical myelopathy due to athetoid cerebral palsy underwent posterior fusion surgery and were included in this study. The Japanese Orthopaedic Association (JOA) score, neck disability index (NDI), C2–7 angle on radiography, and need for additional surgical treatment were examined at 1 and 5 years postoperatively. RESULTS: The mean C2–7 angle was −10.5°±21.1° preoperatively and was corrected to −2.9°±13.5° immediately postoperatively. This improvement was maintained for 5 years. The JOA score was 9.5±2.5 preoperatively and 12.2±1.7 at the 5-year follow-up. NDI was 17±6.9 preoperatively and 16±7.5 at the 5-year follow-up. Patient satisfaction with surgery on a 100-point scale was 62.2±22.5 at the 5-year follow-up. Three patients needed additional surgery for loosening of screws. These results demonstrate good surgical outcomes for posterior fusion at 5 years. CONCLUSIONS: Posterior decompression and fusion should be considered a viable option for cervical myelopathy in patients with athetoid cerebral palsy.
Asian Continental Ancestry Group ; Cerebral Palsy* ; Cohort Studies ; Decompression ; Dyskinesias ; Follow-Up Studies* ; Humans ; Kyphosis ; Neck ; Patient Satisfaction ; Radiography ; Spinal Cord Diseases* ; Spine ; Spondylosis

In Hokkaido, the number of work-related deaths has been decreasing owing to increased safety measure implementation. However, safety measures for non-life-threatening injuries are considered to be insufficient. To reveal the status of non-life-threatening work-related injuries in Tokachi district, we investigated patients with work-related injuries who visited the Orthopaedic Surgery Department of our hospital, which has the only Emergency and Critical Care Center in the district, and examined in detail patients who needed multiple operations. All patients in the Department of Orthopaedic Surgery who had worker’s accident insurance were included in this study. We investigated age, sex, occupation, injury cause, injury site (upper extremity, lower extremity, and/or spine), diagnosis, and number of operations. There were 818 cases of work-related injuries and mean age was 47 (16-82) years. Regarding injury site, 482 patients had upper extremity injury, 273 had lower extremity injury, and 123 had spinal injury. Regarding number of operations, 371 patients had operations and 37 (28 upper extremity injuries and 11 lower extremity injuries) underwent operations more than 3 times. In 19 cases, injuries were caused by the primary industry of employment and 14 by a secondary industry; 19 cases were due to the patient being caught in an industrial machine, mostly agricultural harvesters. Severe injury requiring surgery occurred more than 3 times involved complex injury in the upper extremity or open fracture with soft tissue defect. In Tokachi district, severe limb injury is typically accompanied by soft tissue damage and requires long-term treatment including multiple operations. In future studies, it will be important to conduct detailed evaluation of non-life-threatening work-related injuries, including severe limb injury, and to establish relevant safety measures for such injuries especially those occurring in agricultural workers.

A 71-year-old man presented to our hospital with sudden-onset epigastric pain. He reported a history of undergoing the following operations : aortic valve replacement for aortic regurgitation 11 years earlier and graft replacement of the ascending aorta for acute type A aortic dissection, 1 year earlier. His systolic blood pressure was 70 mmHg, and computed tomography revealed a pseudoaneurysm of the distal anastomosis of the ascending aorta with a connection to the right pulmonary artery. Cardiopulmonary bypass was established with cannulation of the right axillary artery and the right femoral vein, and systemic cooling was initiated before sternotomy. We identified an area showing 3 cm dehiscence at the distal aortic anastomosis after hypothermic circulatory arrest and selective cerebral perfusion. The ascending aorta was replaced as hemiarch replacement, and the defect in the right pulmonary artery was closed with bovine pericardium. The patient's postoperative course was uneventful, and he was transferred to a rehabilitation hospital on the 22nd postoperative day.