痙直型脳性麻痺者の頚椎症性脊髄症の合併について—アテトーゼ型だけではなく

Two Patients with Spastic Cerebral Palsy Complicating Cervical Spondylotic Myelopathy : Not Only Athetoid Type

はじめに

　脳性麻痺のアテトーゼ型では頚椎症性脊髄症（以後，頚髄症と略す）の合併がよく知られているが，痙直型の脳性麻痺ではそうではない．当院で経過観察している痙直型の2症例が頚髄症による機能低下をきたした．痙直型であっても頚髄症の合併症があることを認知し，早期発見と手術が必要と考えられたので報告する．

We report two cases of spastic cerebral palsy classified as diplegia-type complicated cervical spondylotic myelopathy. Under the Gross Motor Function Classification System (GMFCS), both were classified as Level IV, defined as standing with support, but with difficultly, after the diagnosis of cervical spondylotic myelopathy. Paralysis in both the upper and lower limbs deteriorated and became a form of quadriplegia. In one case, there was no appeal from the patient even after the manifestation of symptoms；diagnosis and surgery were both time consuming, with no improvements in post-operative symptoms including urinary incontinence. In the other case, early diagnosis was possible and operation was scheduled early. The post-operative response was positive, and the patient was able to recover to pre-cervical spondylotic myelopathy conditions. Complications of cervical spondylotic myelopathy is well-known in the athetosis type；however, reports on the spastic type are limited. Here, we report complications of cervical spondylotic myelopathy in spastic cerebral palsy and show that early detection and surgery are important factors in mitigating long-term recovery.