Abstract
ObjectiveTo investigate the efficiency of anterior decompression on the proximal‐type cervical spondylotic amyotrophy patients.MethodsThis was a retrospective analysis. From January 2014 to November 2017, 21 patients with proximal‐type cervical spondylotic amyotrophy (CSA) underwent anterior decompression. There were 15 males and 6 females, aged 35–73 years with an average of 51.62 years. All the patients underwent surgery of anterior decompression (ACDF or ACCF). Among them, 12 patients underwent C4/5 single level ACDF, eight patients underwent C4/5 and C5/6 double level ACDF, and one patient underwent C5 anterior cervical corpectomy decompression and fusion surgery. Preoperative and postoperative clinical and radiologic parameters were assessed. The clinical examinations were reviewed, including muscle strength, neck disability index (NDI) score, cervical Japanese Orthopaedic Association (JOA) score, and improvement rate of manual muscle test (MMT) at the last follow‐up. Preoperative spinal cord or nerve impingement was assessed by magnetic resonance imaging (MRI) or computed tomography (CT) myelography. Postoperative lateral X‐ray radiographs were performed every 3 months after the surgery.ResultsSevere preoperative muscle atrophy of the deltoid or biceps muscles occurred in 21 patients included in the study. All of them involve impingements of the ventral nerve root and/or the anterior horn according to MRI and CT myelography. The preoperative duration of symptoms averaged 8.4 months. The average follow‐up for all patients was 13.2 months. At the final follow‐up, all patients showed statistically significant improvements in muscle strength and NDI scores (P < 0.05, P < 0.05). For the deltoid muscles force and C‐JOA scores, the average improvement rates were 66.49% ± 10.04% and 62.23% ± 9.23%, respectively. With respect to MMT, 12 proximal‐type patients were graded excellent, six were good, and three were fair, and the overall improvement rate was 85.7%.ConclusionsFor proximal‐type CSA patients with cervical radiculopathy, earlier anterior decompression surgery can achieve satisfactory results by significantly improving a patient's muscle strength and relieving compression symptoms.
Highlights
To investigate the effect of anterior decompression on cervical spondylotic amyotrophy patients with cervical radiculopathy
Cervical spondylotic amyotrophy (CSA) is an uncommon clinical syndrome which is characterized by muscle atrophy in the upper extremities with no or minimal sensation deficits
The first clinical case of CSA was reported by Keegan in 1965 as “dissociated motor loss in the upper extremities with cervical spondylosis.”[1, 2]
Summary
From January 2012 to December 2016, 21 patients with proximal-type cervical spondylotic amyotrophy(CSA) underwent anterior decompression were included. All patients complained of radicular pain or numbness in unilateral scapular area, shoulder or upper arm which last for 8.8 weeks (2-17 weeks) on average. Patients diagnosed as CSA must meet the following criteria:(1).the presence of unilateral muscle atrophy or impairment of the shoulder girdle muscles;. (2) mild or no sensory disturbance in the upper extremity; (3)magnetic resonance imaging indicating cervical spinal cord compression and/or foraminal stenosis with a varying degree of bulging disc; (4) no gait disturbance. We collected data on patients’ sex, age, surgical approaches, preoperative manual muscle test (MMT) results, JOA scores, VAS score, NDI score, duration of symptoms, levels of spinal canal stenosis, etiological diagnosis, and presence of high-intensity zones (HIZ). Strict physical examination and the upper extremity Electromyography (EMG) was performed at the entry to rule out patients with brachial plexus and peripheral nerve injury (carpal tunnel syndrome, cubital tunnel syndrome, biceps tendonitis, thoracic outlet Syndrome, etc.), cervical flexion myelopathy multifocal motor neuropathy and amyotrophic lateral sclerosis.
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