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. 2025 Jan;15(1):21-30.
doi: 10.1177/21925682241247486. Epub 2024 Apr 17.

Reoperation Rates According to Surgical Approach After Operation for Degenerative Cervical Pathology in Patients With Athetoid Cerebral Palsy: A Nationwide Cohort Study

Jae Jun Yang  1 , Jun Young Choi  1 , Dong-Ho Lee  2 , Chang Ju Hwang  2 , Jae Hwan Cho  2 , Sehan Park  2
Affiliations

Reoperation Rates According to Surgical Approach After Operation for Degenerative Cervical Pathology in Patients With Athetoid Cerebral Palsy: A Nationwide Cohort Study

Jae Jun Yang et al. Global Spine J. 2025 Jan.

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.

Keywords: anterior fusion; athetoid cerebral palsy; cervical spine surgery; combined fusion; laminoplasty; national cohort study; posterior fusion; revision operation.

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Conflict of interest statement

Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Patient selection process.
Figure 2.
Figure 2.
Kaplan–Meier survival curve demonstrating reoperation free survival in each group 0 (blue line): combined fusion, 1 (red line): anterior fusion, 2 (green line): posterior fusion; 3 (brown line): laminoplasty.
See this image and copyright information in PMC

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