Cervical Spondylotic Amyotrophy Patients Research Articles

Additional benefit of ultrasonography to evaluate nerve root condition of degenerative cervical spine disease.

A cross-sectional explanatory study. To clarify the nerve root condition and the association between nerve root cross-sectional area (CA) on ultrasonography (US) and other examinations such as MRI or compound muscle action potentials (CMAPs) in degenerative cervical spine diseases. A university hospital in Japan. Fifty-one patients diagnosed with proximal cervical spondylotic amyotrophy (CSA) (13 patients), cervical radiculopathy of C5 or C6 nerve root (CR) (26 patients), or cervical spondylotic myelopathy (CSM) (12 patients), and twenty-nine healthy volunteers were included in this study. Neurological findings, US findings and CMAPs of deltoid and biceps muscles of all participants were evaluated. In addition, CSA, CR, and CSM patients underwent MRI. A significant correlation was not observed between CA and CMAP amplitude or foraminal diameter on MRI (P > 0.05). In the US examination, the C6 CA of the affected side of the CR group was significantly larger than that of both the normal side and the other groups (P < 0.001). The C5 CA of the affected side of the CSA group clearly showed a bimodal distribution: enlarged and small CA groups. In the CMAP findings, CSA cases respectively showed the lower amplitude of deltoid and bicep CMAPs on both the normal and the affected side (P ≦ 0.01). CSM and healthy volunteers were nearly identical in CA and CMAPs. Utilizing US in addition to NCS and MRI can contribute towards an evaluation of the nerve root condition of degenerative cervical spine disease. no sponsorship.

Increased Cervical Spinal Instability is Associated With the Development of Proximal-type Cervical Spondylotic Amyotrophy.

Retrospective cohort study. We aimed to clarify the clinical relationship between the etiology of proximal-type cervical spondylotic amyotrophy (CSA) and cervical sagittal alignment and instability. Although several researchers have discussed hypotheses regarding the etiology of CSA, the trigger and mechanism underlying the onset remain unclear. We retrospectively analyzed 52 proximal-type CSA patients (CSA group) and 60 control patients (Control group). The following data were collected: age; sex; cervical lordosis (CL); T1 slope (TS); TS-CL; C2-7 sagittal vertical axis (SVA) on x-ray in the neutral position; flexion angle; extension angle and range of motion (ROM) of C3/4, C4/5 and C5/6; and C3/4, C4/5 and C5/6 instability (translation of >3 mm for adjacent segmental segments) on dynamic x-ray. Compared with the Control group, the CSA group was associated with an older age (mean age, 67.6 vs. 61.1 years' old, P= 0.029) and male sex (78.8% vs. 50.0%, P= 0.002). In the CSA group, the radiographic parameters showed smaller C4/5 and C5/6 extension angles and C5/6 ROM values and a greater C3/4 flexion angle than the Control group. Furthermore, compared with the Control group, the CSA group was associated with C3/4 instability (13.5% vs. 3.3%, P= 0.049) and C4/5 (21.2% vs. 3.3%, P = 0.003). A logistic regression analysis, with adjusting for the age and sex, showed that the C3/4 flexion angle (odds ratio [OR], 1.2; 95% confidence interval [CI], 1.08- 1.40, P =0.002), C3/4 instability (OR, 7.3; 95% CI 1.25-42.96, P =0.027) and C4/5 instability (OR, 8.1; 95% CI, 1.56-42.19, P = 0.012) were independent risk factors of CSA. This study suggested that a wide C3/4 flexion angle and high C3/4 or C4/5 spinal instability were closely associated with the etiology of proximal-type CSA.

The Association Between the Rotator Cuff Status and the Severity and Recovery of Weakness in the Shoulder Abductor Strength in a Case of Proximal Type Cervical Spondylotic Amyotrophy.

Study Design:Case series study.Objective:We aimed to clarify the prevalence of rotator cuff tear (RCT), and the association between RCT and the severity and prognosis in patients with proximal type cervical spondylotic amyotrophy (CSA).Methods:We retrospectively analyzed 35 proximal type CSA patients who were treated conservatively. The following data was collected: age, rotator cuff status on MRI, manual muscle test (MMT) score of shoulder abductor and biceps brachii muscles both at the first visit and final follow-up. We investigated the prevalence of RCT and the association between the rotator cuff status, and the severity and recovery of upper extremity weakness in patients with proximal type CSA.Results:Of the 35 patients, 21 had an RCT on MRI, indicating that the prevalence of RCT in patients with proximal type CSA was 60%. An age-adjusted analysis showed that the presence of RCT was significantly associated with the MMT score of the shoulder abductor muscles both at the first visit and at the final follow-up. The presence of RCT was significantly associated with the recovery of the shoulder abductor muscles. The size of the RCT was negatively correlated with the MMT score of the shoulder abductor muscles at the final follow-up. The size of the RCT was independently correlated with the change of the MMT score of the shoulder abductor muscles.Conclusion:RCT was detected in >50% in patients with proximal type CSA, and the presence and severity of RCT can be used as prognostic factors for proximal type CSA patients who are treated conservatively.

Prognostic factors for neurological outcome after anterior decompression and fusion for proximal-type cervical spondylotic amyotrophy – A retrospective analysis of 77 cases

BackgroundDecompression through an anterior approach is theoretically effective for the surgical treatment of cervical spondylotic amyotrophy (CSA), because the pathology usually locates at the anterior side. However, most previous studies investigated posterior surgery or a mix of anterior surgery and posterior surgery in their investigation. Only a few small case series have investigated the surgical outcomes of anterior decompression and fusion (ADF). Therefore, we conducted a multicenter retrospective study that included patients who underwent ADF for proximal-type CSA. MethodsWe analyzed the outcomes of 77 consecutive spinal surgeries performed on proximal-type CSA patients who underwent ADF. Preoperative and postoperative manual muscle tests (MMT) and the patients’ backgrounds, radiological findings, and complications were reviewed. We divided the cases into two groups, good-outcome group (MMT improvement ≧ 2 or improved to MMT 5) and poor-outcome group (others) and evaluated the prognostic factors for outcomes. ResultsOf the 77 patients, 48 (62%) showed good neurological outcome. Multiple compressive lesions at anterior horn (AH) and/or ventral nerve roots (VNRs) were detected in 66 patients (85.7%) on the magnetic resonance images. The patients with a single compressive lesion at VNR or AH tended to show good neurological recovery when compare to those with multiple lesions. Age and duration of symptoms were related to the poor outcome in univariate analysis. Duration of symptoms was an independent factor associated with postoperative neurological outcome. The cut-off value for poor outcome was 7.0 months for the symptom duration (sensitivity: 79%, specificity: 54%, area under the curve: 0.69). ConclusionsPatients with proximal-CSA were more likely to have multiple compressive lesions at an AH and/or a VNR. The prognostic factor for poor neurological outcome was duration of symptoms of ≥7 months.

Evaluation of Anterior Decompression Surgical Outcomes of Proximal-Type Cervical Spondylotic Amyotrophy: A Retrospective Study.

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.

Split-hand phenomenon quantified by the motor unit number index for distinguishing cervical spondylotic amyotrophy from amyotrophic lateral sclerosis

To investigate and compare split-hand phenomenon quantified by motor unit number index (MUNIX) between patients with cervical spondylotic amyotrophy (CSA) and those with amyotrophic lateral sclerosis (ALS). MUNIX was performed on abductor pollicis brevis (APB), abductor digiti minimi (ADM) and first dorsal interosseous (FDI) in 46 CSA patients, 39 ALS patients and 41 healthy subjects. Split-hand measurements including split-hand index (SHI=ABP×FDI/ADM), ratio of APB to ADM (AA), ratio of FDI to ADM (FA) were measured by compound muscle action potential (CMAP) and MUNIX. There was a significant difference in both AA and SHI measured by two different methods between ALS and CSA patients (P<0.05). Receiver operating characteristic (ROC) curve and logistic regression analysis demonstrated good differential diagnostic accuracy for AA, SHI and their combination between ALS and CSA. A larger area under the curve (AUC) was observed in these measurements calculated by MUNIX than those measured by CMAP (AA: 0.885 vs. 0.700, SHI: 0.865 vs. 0.703, Combination: 0.925 vs. 0.750; P<0.05). Sub-group analysis of ROC curves revealed an AUC of 0.893 for AAMUNIX, 0.801 for SHIMUNIX and 0.896 for their combination in differentiating "clinically possible" ALS (Awaji-Shima criteria) from CSA (P<0.05). Both AA and SHI measured by two different methods are useful in distinguishing ALS from CSA, and those quantified by MUNIX may be a better differential diagnostic marker to provide an accurate and noninvasive additional test for distinguishing CSA from ALS, even in their early stages.

Surgical outcomes for distal-type cervical spondylotic amyotrophy: a multicenter retrospective analysis of 43 cases.

Distal-type cervical spondylotic amyotrophy (CSA) is a rare form of cervical spondylosis that causes muscle weakness of upper extremities. The pathophysiology and appropriate surgical method for the treatment of CSA are still controversial. We investigated clinical outcomes in surgically treated distal-type CSA. The authors executed an analysis of the outcomes of 43 consecutive spinal surgeries performed in distal-type CSA patients. The duration of symptoms, perioperative manual muscle test (MMT) results, radiological findings, and perioperative complications were reviewed. We compared surgical outcomes between different approaches and examined the factors related to poor outcomes (MMT improvement ≤ 0) after surgery. The pathophysiology of CSA was mostly caused by a combination of multiple lesions in the anterior horn and/or nerve root. Nineteen of 29 patients (65.5%) who received anterior approach methods were included in the good outcome group (MMT improvement ≥ 1), whereas 7 of 14 patients (50.0%) in the posterior group were classified as good. In the anterior group, the mean MMT grade significantly improved from 2.6 to 3.4 (p = 0.0035) despite the higher rate of complications. The duration of symptoms was substantially associated with poor outcomes. The MMT grade significantly improved from 2.2 to 3.2 (p = 0.0118) in the < 6months group. Cervical alignments and preoperative MMT grade were not statistically associated with poor outcomes. Patients with poor outcomes had symptoms for a longer duration. We found tolerable clinical outcomes within 6months from onset. The anterior approaches might be recommended because this procedure significantly improved MMT levels in the hands. These slides can be retrieved under Electronic Supplementary Material.

Motor unit number index (MUNIX) in the quantitative assessment of severity and surgical outcome in cervical spondylotic amyotrophy

ObjectiveTo assess the feasibility of motor unit number index (MUNIX) in the quantitative assessment of the cervical spondylotic amyotrophy (CSA). MethodsMUNIX was recorded bilaterally on the abductor pollicis brevis, abductor digiti minimi, biceps brachii and middle deltoid in 41 normal controls and 47 patients with CSA (distal-type to proximal-type ratio: 25 to 22). Additionally, patients were assessed on handgrip strength (HGS), the disabilities of arm, shoulder and hand (DASH) and Medical Research Council (MRC) scales. These examinations were re-evaluated approximately 18 months after surgery in 37 of these CSA patients. ResultsMUNIX values were noticeably lower in the mainly affected muscles of CSA patients than those in controls (P < 0.05), and 49.0% (51/104) of the tested muscles with abnormal MUNIX measurements showed normal muscle strength. Significant correlations between MUNIX measurements and both DASH and MRC scores were observed in both CSA patient groups (P < 0.05). Postoperative longitudinal follow-up analysis identified significant increase in motor unit number in both CSA patient groups within approximately 18 months (P < 0.05), with or without improved measures of motor function. ConclusionsA significant reduction in MUNIX values related to motor impairment was observed in CSA patients, even in the subclinical stage. Compared to measures of motor function, the MUNIX measurements in the patients with CSA improved more noticeably after surgical intervention. SignificanceMUNIX may serve as an available supplementary test to quantitatively evaluate the motor dysfunction in CSA and to track its progression, that is complementary to conventional electromyography.

T25. Changes in central motor conduction time and its implication in the pathogenesis of distal-type cervical spondylotic amyotrophy

The true pathogenesis of cervical spondylotic amyotrophy (CSA) remains controversial. One of the current hypotheses for the etiology of CSA mainly involves selective compression of the ventral nerve roots and/or anterior horn cells by a bony spur or herniated disc. Some scholars have proposed that CSA may be ascribed to ischemia of anterior horn cells caused by compressive injury of anterior spinal artery. Recently published studies demonstrated that chronic incomplete cervical cord compression can cause the loss of motor neurons in the spinal anterior horn caudal to the level of the compressive injury, which was described as trans-synaptic damage. Although CSA was previously considered a neurological disease involving only lower motor neurons (LMNs), some authors revealed that approximately 28.6–66.7% of distal-type CSA patients had significant lower limb hyperreflexia, which is consistent with upper motor neuron (UMN) lesions. Therefore, trans-synaptic damage may be involved in the pathogenesis of distal-type CSA. The present study has been undertaken to evaluate central motor conduction in distal-type CSA patients and to analyze the role of trans-synaptic damage in the pathogenesis of distal-type CSA. Central motor conduction time (CMCT) to both upper and lower limbs was measured in 28 distal-type CSA patients and 21 controls, and all subjects underwent further motor unit number estimation (MUNE), handgrip strength examination (HGS) and magnetic resonance imaging evaluation. Prolonged CMCT was recorded in 9/28 (32.1%) CSA patients, and both lower MUNE values and smaller HGS were observed in these 9 cases (P < 0.05). Imaging analysis demonstrated that 5 of these 9 cases had cervical compression both proximally and distally, and severe proximal cervical compression without distal selective compression was found in the other two cases (2/9, 22.2%). There was an inverse correlation between CMCT and both MUNE values and HGS on symptomatic side (P < 0.05), and a positive relationship between CMCT and amplitude of single motor unit potentials was found on less-symptomatic side (P < 0.05). Distal-type CSA patients may have substantial corticospinal tract lesions, and trans-synaptic damage caused by these lesions may be involved in the pathogenesis of distal-type CSA. Therefore, clinicians should be cautious when evaluating and managing distal-type CSA patients, especially the cases with additional proximal cervical compression, because severe muscular atrophy may be caused by both trans-synaptic damage and selective compression.

Biceps-Related Physical Findings Are Useful to Prevent Misdiagnosis of Cervical Spondylotic Amyotrophy as a Rotator Cuff Tear.

Study DesignCase–control study.PurposeThe aim of the present study was to identify physical findings useful for differentiating between cervical spondylotic amyotrophy (CSA) and rotator cuff tears to prevent the misdiagnosis of CSA as a rotator cuff tear.Overview of LiteratureCSA and rotator cuff tears are often confused among patients presenting with difficulty in shoulder elevation.MethodsTwenty-five patients with CSA and 27 with rotator cuff tears were enrolled. We included five physical findings specific to CSA that were observed in both CSA and rotator cuff tear patients. The findings were as follows: (1) weakness of the deltoid muscle, (2) weakness of the biceps muscle, (3) atrophy of the deltoid muscle, (4) atrophy of the biceps muscle, and (5) swallow-tail sign (assessment of the posterior fibers of the deltoid).ResultsAmong 25 CSA patients, 10 (40.0%) were misdiagnosed with a rotator cuff tear on initial diagnosis. The sensitivity and specificity of each physical finding were as follows: (1) deltoid weakness (sensitivity, 92.0%; specificity, 55.6%), (2) biceps weakness (sensitivity, 80.0%; specificity, 100%), (3) deltoid atrophy (sensitivity, 96.0%; specificity, 77.8%), (4) biceps atrophy (sensitivity, 88.8%; specificity, 92.6%), and (5) swallow-tail sign (sensitivity, 56.0%; specificity, 74.1%). There were statistically significant differences in each physical finding.ConclusionsCSA is likely to be misdiagnosed as a rotator cuff tear; however, weakness and atrophy of the biceps are useful findings for differentiating between CSA and rotator cuff tears to prevent misdiagnosis.

Evidence that impaired motor conduction in the bilateral ulnar and tibial nerves underlies cervical spondylotic amyotrophy in patients with unilateral deltoid muscle atrophy.

Introduction The clinical entity of cervical spondylotic amyotrophy (CSA) is characterized by severe muscle atrophy in the upper extremities with insignificant sensory deficits in patients with cervical spondylosis. However, the pathogenesis of CSA is still unclear. Methods We assessed electrophysiological motor conduction through the corticospinal tract and ulnar and tibial nerves, which do not supply the deltoid or biceps muscles, of 18 patients with CSA, 12 patients with compressive cervical myelopathy, and 18 control subjects with cervical spondylotic radiculopathy. Motor evoked potentials following transcranial magnetic stimulation and M-waves and F-waves following electrical stimulation were measured from the bilateral abductor digiti minimi muscles (ADMs) and abductor hallucis muscles (AHs). The peripheral conduction time (PCT) was calculated from the latencies of the CMAPs and F-waves as follows: (latency of CMAPs + latency of F-waves - 1) / 2. The central motor conduction time (CMCT) was calculated by subtracting the PCT from the onset latency of the MEPs. Results The M-wave (M) latency and minimum F-wave (Fmin) latency from the ADM, and Fmin-M latency from the ADM/AH were significantly longer in the CSA group than in the other groups, on both the affected (p = 0.000-0.007) and unaffected sides (p = 0.000-0.033). F-wave persistence from the bilateral ADMs was significantly lower in the CSA group than in the other groups (p = 0.000-0.002). Among the CSA patients, there were no significant differences in these parameters between the affected and unaffected sides. The CMCT showed no significant differences between the CSA and control groups, but significant differences between the CSA and CCM groups (p = 0.000-0.004). Conclusions CSA patients with unilateral deltoid muscle atrophy had subclinical impairments of lower motor neurons and/or peripheral axons in the ulnar nerve, and subclinical impairments of peripheral axons in the tibial nerve. These motor impairments may have originally existed in these individuals before the onset of CSA.

Value of split hand in the differential diagnosis of amyotrophic lateral sclerosis and cervical spondylotic amyotrophy

Objective: To investigate the value of split hand in the differential diagnosis of amyotrophic lateral sclerosis(ALS) and cervical spondylotic amyotrophy (CSA). Methods: A total of 62 ALS patients, 57 CSA patients and 65 normal controls who visited the Neurology and Spine Department of Beijing Jishuitan Hospital from May 2013 to June 2017 were enrolled into this study.The amplitudes of compound muscle action potentials (CMAP) were recorded from abductor digiti minimi (ADM) and abductor pollicis brevis (APB). Moreover, the ratio of CMAP amplitude between ADM and APB (ADM/APB) was calculated. Results: The ADM/APB of the ALS group (1.93±1.97)was significantly higher than that of the normal control group (0.92±0.22)(P<0.05); the ADM/APB of the CSA group (0.74±0.32)was significantly lower than that of the normal control group (0.92±0.22)(P<0.05); the ADM/APB of the ALS group (1.93±1.97)was significantly higher than that of the CSA group(0.74±0.32)(P<0.05); the areas under receiver operator characteristic curve in patients with ALS was 0.843, the diagnostic sensitivity and specificity for ALS were 75.8% and 83.1% with the cutoff value of ADM/APB=1.077; the areas under receiver operator characteristic curve in patients with CSA was 0.737, the diagnostic sensitivity and specificity for CSA were 64.9% and 87.1% with the cutoff value of ADM/APB=0.739. Conclusion: The ADM/APB has certain clinical value for the differentiation of ALS and CSA.

Clinical diagnosis and management of cervical spondylotic amyotrophy

Objective: To investigate the clinical characteristics and surgical treatment of cervical spondylotic amyotrophy. Methods: Thirteen patients(13 man) with proximal (10) and distal(3) cervical spondylotic amyotrophy between November 2014 and September 2016 were included in this study. The average age of the patients was 55 (range, 47-66) years. The sex, age, clinical course, type of amyotrophy, lesion segment and postdecompression improvement in muscle power were reviewed. Results: Of 13 cervical spondylotic amyotrophy patients, 9 were performed on with cervical disectomy, 2 were performed on with cervical posterior operation, 2 remainding patients received nonoperative treatment. Cervical spondylotic amyotrophy patients were followed up 6-22 (average 10.6) months, muscle power of 4 patients (all proximal-type)were improved completely (the average recovery time were 4.4 months), muscle power of 6 patients were improved uncompletely, 1 patients failed to improve, the 2 remainding patients received nonoperative treatment had no change. Conclusion: Cervical spondylotic amyotrophy as a rare type of cervical spondylotic disorder, It should distinguish cervical spondylotic amyotrophy from amyotrophic lateral sclerosis, especially in the early stage of amyotrophic lateral sclerosis. A surgical treatment is recommended as the first line of proximal-type CSA, especially those with serious compression. It is important that clinicians should be aware that distal-type CSA had a poor results, resulting in a lower lower satisfaction, especially those with no, or insignificant, sensory disturbance.

Terminal latency abnormality in amyotrophic lateral sclerosis without split hand syndrome

Amyotrophic lateral sclerosis (ALS) has a peculiar involvement pattern; clinically it is known as split hand syndrome and electrophysiologically shows abnormalities in the abductor pollicis brevis (APB)/abductor digiti minimi (ADM) ratio. The aim of this study was to find a significant electrophysiological parameter in upper limb onset ALS patients with normal APB/ADM ratio when compared to cervical spondylotic amyotrophy (CSA) and healthy controls. We retrospectively reviewed the electrophysiological results of 47 upper limb onset ALS and 42 CSA cases; 20 healthy individuals were included as controls. We included ALS and CSA patients with normal ADM/APB ratio (≥0.6, and ≤1.7), and the parameters of electrophysiological study were compared. The electrophysiological parameters of statistical significance among ALS, CSA and normal controls were: amplitude of median and ulnar nerves, the terminal latency of median nerve, F-wave latency of median and ulnar nerves, terminal latency ratio of ulnar/median nerves, and F-wave latency ratio of ulnar/median nerves (p<0.05). Among these parameters, the terminal latency ratio of ulnar/median nerve and terminal latency of median nerve in ALS were significantly different with both of CSA and normal control (p<0.006). The abnormality in the terminal latency of the median nerve can be partly explained by the distal motor axonal dysfunction due to sodium and potassium channel abnormalities. The hypothesis of distal axonopathy is known to play an important role in the pathogenesis of ALS causing a significant prolongation of the terminal latency in the median nerve and the ulnar/median nerve ratio.

Evaluation of characteristics and surgical outcomes in cervical spondylotic amyotrophy.

Background:Cervical spondylotic amyotrophy (CSA) is a rare clinical syndrome resulting from cervical spondylosis. Surgical treatment includes anterior cervical decompression and fusion (ACDF), and laminoplasty with or without foraminotomy. Some studies indicate that ACDF is an effective method for treating CSA because anterior decompression with or without medial foraminotomy can completely eliminate anterior and/or anterolateral lesions. We retrospectively evaluated outcome of surgical outcome by anterior cervical decompression and fusion (ACDF).Materials and Methods:28 CSA patients, among whom 12 had proximal type CSA and 16 had distal type CSA, treated by ACDF, were evaluated clinicoradiologically. The improvement in atrophic muscle power was assessed by manual muscle testing (MMT) and the recovery rate of the patients was determined on the basis of the Japanese Orthopedic Association (JOA) scores. Patient satisfaction was also examined.Results:The percentage of patients, who gained 1 or more grades of muscle power improvement, as determined by MMT, was 91.7% for those with proximal type CSA and 37.5% for those with distal type CSA (P < 0.01). The JOA score-based recovery rates of patients with proximal type and distal type CSA were 60.8% and 41.8%, respectively (P < 0.05). Patient satisfaction was 8.2 for those with proximal type CSA and 6.9 for those with distal type CSA (P < 0.01). A correlation was observed among the levels of improvement in muscle power, JOA score based recovery rate, patient satisfaction and course of disease (P < 0.05).Conclusion:ACDF can effectively improve the clinical function of patients with CSA and result in good patient satisfaction despite the surgical outcomes for distal type CSA being inferior to those for proximal type CSA. Course of disease is the fundamental factor that affects the surgical outcomes for CSA. We recommend that patients with CSA undergo surgical intervention as early as possible.

Risk factors for a poor outcome following surgical treatment of cervical spondylotic amyotrophy: a multicenter study

Cervical spondylotic amyotrophy (CSA) is characterized by muscle atrophy in the upper extremities without gait disturbance. However, the indications and outcomes of surgical treatment for CSA have not been clarified. The purpose of this study was to determine the risk factors for a poor outcome following surgical treatment of CSA. We performed a retrospective review of CSA in patients from 1991 to 2010 through a multicenter study. We collected information regarding age, type of muscle atrophy, preoperative manual muscle test (MMT), duration of symptoms, high-intensity areas on T2-weighted MR images, low-intensity areas on T1-weighted MR images, levels of spinal canal stenosis, cervical kyphosis and surgical procedures (laminoplasty, anterior cervical discectomy and fusion and posterior spinal fusion), and calculated overall risk factors related to a poor outcome following surgery. Univariate analyses and multivariate logistic regression analysis were performed to identify correlates of a poor outcome. Fifty-nine patients, 95 % male (56 patients), were included in our analysis with a mean age of 59 years (range 32-78 years). Eighteen patients did not improve after surgery. Symptom duration (OR = 1.263), preoperative MMT grade (OR = 0.169) and distal type of CSA (OR = 9.223) were all associated with an increased risk of a poor surgical outcome. Early surgery is recommended for CSA patients in whom conservative treatment has not been successful. We also recommend surgery for patients who have severe preoperative muscle weakness or have the distal type of CSA.

Clinical Outcomes and Predictive Factors Relating to Prognosis of Conservative and Surgical Treatments for Cervical Spondylotic Amyotrophy

Retrospective clinical analyses of patients with cervical spondylotic amyotrophy (CSA). To report the clinical outcomes and predictive factors relating to the prognosis in conservative and surgical treatments for CSA. CSA is a clinical entity characterized by muscle atrophy in the upper extremity without marked sensory disturbance or spastic tetraparesis. The indications for, and outcomes of conservative and surgical treatments for CSA have not been clearly enunciated. Ninety patients with CSA were enrolled in this study. All of them initially received continuous cervical traction for 2 to 3 weeks as inpatients. If this conservative treatment was ineffective, surgical intervention was carried out after informed consent was obtained. We investigated the outcome of conservative treatment, the predictive factors relating to the prognosis of the conservative treatment, and the outcome of surgery after initial conservative treatment failed. After initial conservative treatment, 42 patients (46.7%) showed excellent or good outcome, 29 patients underwent surgery, and 19 patients declined surgery. Consequently, 61 patients were conservatively followed up. At final follow-up, 40% of the patients still showed excellent or good neurologic status by conservative treatment, and this group was characterized by age <50 years, duration of symptoms <6 months, single-level stenosis, foraminal stenosis, and a good response to traction therapy. Additional 5 patients underwent surgery during follow-up because of deterioration of symptom, and 34 patients consequently underwent surgery at the final follow-up. Of 34, 28 (82%) patients who underwent surgery obtained neurologic improvement. The present study has demonstrated the outcome of conservative and of surgical treatments for CSA, together with the predictive factors relating to the prognosis. Conservative treatment should be initially tried on CSA patients, especially those with predictive factors relating to a better prognosis. However, if conservative treatment failed, surgical intervention was successful.

Conservative treatment with hyperbaric oxygen therapy for cervical spondylotic amyotrophy

Small case series of patients with cervical spondylotic amyotrophy (CSA) managed by conservative treatment with hyperbaric oxygen (HBO) therapy. To study the effects of conservative treatment with HBO therapy of CSA patients. Department of Orthopaedic Surgery, Imakiire General Hospital, Kagoshima, Japan. This study included 10 patients with CSA who underwent rehabilitation, including cervical traction and muscle exercise, for some period of time but did not respond well to it, and were then managed by additional HBO therapy for rehabilitation. Information was obtained on the duration of symptoms and strength of the most atrophic muscle, intramedullary high-signal-intensity changes on T2-weighted magnetic resonance imaging, presence of 'snake-eyes' appearance and the number of stenotic canal levels. The mean duration of symptoms before HBO treatment was 3.1 months. The axial T2-weighted magnetic resonance images of all 10 patients showed a 'snake-eyes' appearance. The mean number of stenotic canal levels was 0.3. There was marked improvement on manual muscle testing from a mean of 1.9 pretreatment to a mean of 4.4 at the last follow-up after HBO therapy. The outcomes of all 10 patients, whose results were classified as excellent or good, were considered clinically satisfactory. To our knowledge, conservative treatment with HBO therapy for CSA patients has not previously been described. It appears that HBO therapy might improve ischemic injury of the anterior horns in CSA patients with short duration of symptoms.

Surgical treatment of cervical spondylotic amyotrophy

To investigate the clinical characteristics and treatment of cervical spondylotic amyotrophy. 9 cervical spondylotic amyotrophy patients and 15 cervical radiculopathy, myelopathy spondylosis patients were included in this study. Their clinical manifestation, MRI image results and treatment were analysis. Of 9 cervical spondylotic amyotrophy patients, 7 cases were done with cervical discectomy, 2 cases were done with combined cervical anterior and posterior operation; of 15 radiculopathy, myelopathy spondylosis patients, 12 cases were done with cervical discectomy, 3 cases were done with combined cervical anterior and posterior operation. Cervical spondylotic amyotrophy patients were followed up 6-36 months, muscle power of 9 patients were improved markedly, muscle power of 6 patients were improved from grade II preoperation to grade IV-V postoperation after operation 6 months, relief rate is 75%-100%, that of 2 patients were improved from grade III preoperation to grade IV-V postoperation, relief rate is 50% and 100% respectively, that of 1 patient (multiple segments) were improved from grade I preoperation to grade III postoperation, relief rate is 50%; 8 patients were followed up over 12 months, muscle power of 7 patients were improved to grade V, relief rate is 100%, that of 1 patient were improved to grade IV, relief rate is 80%. Cervical radiculopathy, myelopathy spondylosis patients were followed up 12-36 months, muscle power of 15 patients were improved respectively, muscle power of 15 patients were improved from grade II-IV preoperation to grade III-V postoperation after operation 6 months, relief rate is 20%-100%, all 15 patients were followed up over 12 months, muscle power of 11 patients were improved to grade V, relief rate is 100%, that of 3 patient were improved to grade IV, relief rate is 20%-50%, that of 1 case keep unchanged. Cervical spondylotic amyotrophy is a rare type of cervical spondylotic disorder, it is easily misdiagnosed because it is confused with motor neuron disease. MRI and electromyography can help to diagnose. The mechanism of cervical spondylotic amyotrophy maybe is that compression of anterior horn of spinal cord or ischemic injury of spinal cord. Surgical treatment can help to improve muscle power, prognosis of single segment is better than that of multiple segments.