Snake Eyes Research Articles

Snake eyes: Characterization of topical ocular exposures from rattlesnakes in Arizona

Patients occasionally present with reports of ocular exposure to fluids from rattlesnakes, claiming or suspecting the substance to be venom. This study set out to evaluate and characterize reported cases of suspected venom-induced ophthalmia in humans. A retrospective review of rattlesnake exposures reported to the Arizona Poison and Drug Information Center over a 24-year period was conducted for ocular exposures. Recorded information included patient demographics, clinical course, laboratory results, and treatments. Documentation regarding interactions between patients and snakes was reviewed by Arizona Poison and Drug Information Center herpetologists to evaluate what substance was expelled from the snake resulting in ocular exposure. Our review of rattlesnake encounters found a total of 26 ocular exposure cases. Patient demographics were largely intentional interactions and involved the male sex. Symptoms ranged from asymptomatic to minor effects with 46.2% managed from home and treated with fluid irrigation. A review of cases by herpetologists concluded the exposure patients commonly experienced was to snake musk. Kinematics of venom expulsion by rattlesnakes conclude the venom gland must be compressed, fangs erected to ≥60o, and fang sheath compressed against the roof of the mouth for venom expulsion. Evidence suggests the chance of venom “spitting” by rattlesnakes is close to zero. Rattlesnakes are documented to forcefully expel airborne malodorous “musk” defensively. An important distinction to remember is musk has a foul odor and is usually colorless, while venom is comparatively odorless and yellow. Rattlesnake venom-induced ophthalmia is a rare event as venom expulsion requires the kinematics of feeding or defensive bites. If the rattlesnake is not in the process of biting or otherwise contacting some other object with its mouth, it is more biologically plausible patients are being exposed to snake musk as a deterrent. Whether it's venom or musk, topical exposure to the eyes should prompt immediate irrigation.

Lower motor neuron disease with MRI «snake eyes» pattern

Motor neuron disease with isolated or predominant lesion of the lower motor neuron at one level of the pyramidal tract is a rare diagnostic finding. In the article, we analyze the case of a patient with asymmetric lesion of the inferior motor neuron at the cervical level: clinical manifestations, results of additional studies and dynamic observation of the patient. Special attention is paid to the MRI picture of changes in the pyramidal tracts in the cervical region, which have been called the «snake eyes» in the literature, and the impact of this finding on the diagnosis and prognosis of the disease.

Anterior spinal artery infarction: study of a case in the neurology department of the CHU Ignace Deen in Conakry

Introduction: Spinal cord infarction corresponds to all the clinical manifestations secondary to ischemia of part or all of the spinal cord, whether sudden or progressive. It is a rare condition with a difficult diagnosis affecting only 1.2% of patients admitted to the neurovascular pathologies department. It is most frequently located in the territory of the anterior spinal artery (66.7%). Observation: 43-year-old patient with a lifestyle of repeatedly carrying heavy weights on the head, presenting with neck pain radiating to the upper limbs and tetra paresis. The clinic is characterized by anterior spinal artery syndrome, a lesional and sublesional syndrome and the spinal MRI revealed an extensive T2 hyper signal localized at the level of the anterior horn producing the characteristic appearance of snake eyes evoking an infarction in the territory of the anterior spinal artery. Conclusion: It is a diagnosis which remains difficult and is based on the comparison of clinical and para-clinical data.

Cervical Spondylotic Amyotrophy Initially Misdiagnosed as Amyotrophic Lateral Sclerosis

A 63-year-old man diagnosed with mixed-type cervical spondylotic amyotrophy exhibited severe atrophy in the right biceps brachii, teres major, and intrinsic hand muscles, resulting in level 3 muscle weakness. Magnetic resonance imaging showed symmetrical high signal, also referred to as the snake eye sign. Previously, he was erroneously diagnosed with amyotrophic lateral sclerosis. He had undergone anterior cervical surgery 7 years prior. At present, his right upper limb muscles display minimal atrophy compared with the left, with muscle strength nearing level 4, which is considered normal. We believe that prompt surgical intervention on diagnosis of cervical spondylotic amyotrophy, along with comprehensive postsurgery rehabilitation, can halt further deterioration of the condition and accelerate recovery.

A Case Report of Hirayama Disease Revealed by Upper Limb Weakness and Wasting

Hirayama disease is a rare entity characterized by unilateral or asymmetrical bilateral focal weakness and wasting of muscles innervated by C7, C8, and T1. We report the case of a 20-year-old male who presented with gradual left upper limb weakness and wasting, confirmed by electrophysiological and radiological studies showing detachment of the posterior longitudinal ligament with dilatation of the epidural veins. Anterior displacement with flattening of the medullary cord from C4 to C7 was observed, where there was a T2 hypersignal abnormality involving the anterior horns and producing a "snake eye" appearance. The disease is believed to result from the forward displacement of the cervical dural sac and spinal cord induced by neck flexion, and should be suspected in male patients presenting with unilateral or asymmetrical bilateral lower motor weakness of hands and forearms.

Review: Keep Sweet: Pray and Obey, directed by Rachel Dretzin

The Netflix documentary series Keep Sweet: Pray and Obey features interviews with participants in the Fundamentalist Church of Latter Day Saints (FLDS) who relate their experiences living under the leadership of Rulon Jeffs and his son Warren. It differs from Hulu’s miniseries Under the Banner of Heaven, which is a fictional retelling of Jon Krakauer’s book about Brigham Young in the nineteenth century and the Lafferty murders in the twentieth (reviewed in this issue). Although Keep Sweet includes clearly identified reenactments of events, its strength lies in the personal accounts of former members, as well as in historical photos, TV footage, and most chilling, an audiotape of Warren Jeffs as he is about to rape a twelve-year-old girl.The first two episodes show some of the attractions, as well as tribulations, of polygamous life—large families full of children, sister wives who may be competitors or cooperators, a clear identity and purpose, and most important, the pathway to eternal salvation. Despite the irony inherent in the title—taken from the exhortations of Warren Jeffs—some of these positive elements are apparent as the tale initially unfolds. Yet sexual abuse and criminal activity become the focus of the last two episodes, with the move to Eldorado, Texas, and the construction of the Yearning for Zion Ranch. It is here that the series earns its identification on IMDb as “Documentary, Crime.” In other words, this isn’t really a series about the FLDS or plural marriage. It’s an exposé—and a deserved one—of the heinous practices of men trafficking (as several people call the arranged marriages) in young women, including minors. Yet the filmmakers had to go over the top and put snake eyes on Warren Jeffs’ image and play rattles from a snake on the soundtrack. This cheapened, rather than enhanced, the gripping tales survivors told.The sincerity, honesty, and courage of the young women who shared their stories was remarkable, while the narratives of men expelled from the movement were also compelling. I don’t recall any former members use the word “brainwashing” in their admission of absolute and complete devotion to the Prophet. They had been raised to believe Warren Jeffs was not just God’s representative on earth, but God himself. They paid a high price for that belief.

Reader Response: Teaching NeuroImage: Leber Hereditary Optic Neuropathy With Longitudinal Spinal Cord Lesion Mimicking Spinal Cord Infarction.

We thank Zhao et al.1 for presenting an interesting case of a longitudinally extensive spinal cord lesion in a patient with a mitochondrial sequence variant. The authors suggest that the neuroimaging mimics spinal cord infarction (SCI). However, the initial MRI shows a swollen, expanded, and enhancing spinal cord lesion. This appearance is typical for neuromyelitis optic spectrum disorders or other inflammatory myelopathies, rather than SCI. While acute snake eye appearance suggests SCI, it is usually nonenhancing, and an early MRI could be normal.2 In addition, evidence for the efficacy of idebenone for the treatment of optic neuropathy in Leber Hereditary Optic neuropathy (LHON) is modest at best,3 making it difficult to attribute this patient's recovery to idebenone. Was the patient treated with steroids or another immunotherapy acutely? In our opinion, it is likely that this patient, who harbors a familial mitochondrial sequence variant, presented with inflammatory myelopathy. Association of LHON and multiple sclerosis or antiaquaporin-4 disease is known and likely responsible for the aggressive presentation here4,5; however, causality is not proven. While we agree with the authors that consideration of underlying mitochondrial disorders in the right clinical scenario is important, ongoing neuroimmunology surveillance is prudent, and on relapse, the case may warrant immunotherapy.

The relationship between hard and soft tissue structures of the eye in extant lizards.

The sizes of the eye structures, such as the lens diameter and the axial length, are important factors for the visual performance and are considered to be related to the mode of life. Although the size of these soft structures cannot be directly observed in fossil taxa, such information may be obtained from measuring size and morphology of the bony scleral ossicle ring, which is present in the eyes of extant saurospids, excluding crocodiles and snakes, and is variously preserved in fossil taxa. However, there have been only a few studies investigating the relationships between the size, the scleral ossicle ring, and soft structures of the eye. We investigated such relationships among the eye structures in extant Squamata, to establish the basis for inferring the size of the soft structures in the eye in fossil squamates. Three‐dimensional morphological data on the eye and head region of 59 lizard species covering most major clades were collected using micro‐computed tomography scanners. Strong correlations were found between the internal and external diameters of the scleral ossicle ring and soft structures. The tight correlations found here will allow reliable estimations of the sizes of soft structures and inferences on the visual performance and mode of life in fossil squamates, based on the diameters of their preserved scleral ossicle rings. Furthermore, the comparison of the allometric relationships between structures in squamates eyes with those in avian eyes suggest the possibility that the similarities of these structures closely reflect the mechanism of accommodation.

A Review on the Morphology, Nutritional Value, Traditional Uses, Phytochemistry, and Biological Activities of Pycnarrhena cauliflora and Its Synonyms

The leaves of Pycnarrhena cauliflora, locally known as ‘pokok Ajinomoto’, are consumed as flavour enhancers by East Malaysian communities. The plant also plays a significant role in traditional medicine especially to treat snake bites, eye irritation, headache, and seizures. An extensive literature search on the species revealed that besides taxonomic description as well as toxicity against HeLa human cervical and breast cancer cell lines, there is no report on the plant chemistry. The species has nevertheless been classified as the synonym of several other species which are Antitaxis cauliflora Miers., Pycnarrhena longifolia, (Decne. ex Miq.), Antitaxis longifolius (Decne. ex Miq.) Mier., and Gabila longifolia (Decne. ex Miq, B). Among these synonyms, the plant is closely related to the species P. longifolia. Thus, a complete review of P. cauliflora and its synonyms is important to revise and evaluate its potential for further studies and commercialisation. The information on the species was collected from scientific journals, books, and reports searched through available databases such as Google Scholar, PubMed, Directory of Open Access Journals, Science Direct, Bioline International and Reaxys. This review provides an insight on the morphology, nutritional value, traditional uses, phytochemistry, and biological activities of P. cauliflora and its synonyms published between 1981 to 2021 in scientific journals, books, and reports.

Anterior Spinal Cord Ischemia due to an Acute Aortic Intramural Type B Hematoma

Anterior Spinal Cord Ischemia due to an Acute Aortic Intramural Type B Hematoma

Size of Snake Eyes Correlates With Habitat Types and Diel Activity Patterns

Eye size influences visual acuity, sensitivity, and temporal resolution and is a result of vertebrate adaptation to the environment. The habitats of snake species are diverse, ranging from fossorial, terrestrial, arboreal, to aquatic. They also demonstrate a variety of behavioral and physiological characteristics, such as activity time, feeding patterns, and prey detection. In this study, we comparatively investigated how the relative eye size (i.e., eye diameter vs. head width) associated with the ecological (i.e., habitat), behavioral (i.e., diel activity pattern, foraging strategy), and physiological traits (i.e., the presence of pits), respectively, across six snake families from Taiwan. Among the traits we examined, we found that terrestrial and/or diurnal snakes tended to exhibit the larger relative eye size, indicating the evolutionary responses of eye size to changes in habitat types and activity patterns, respectively, while no evidence of how foraging strategies and the presence of pits affected snake eye size was found. Our findings not only shed light on the adaptive significance of the visual system in diversifying the behaviors and the environments exploited in snakes, but also underline the interactive effects of multidimensional evolutionary attributes (e.g., behavior, ecology, physiology and phylogeny) on the evolution of optimal visual performance.

Snake Eyes. A Natural History of Picturing, Perception, and the Serpents That Lurk Within

Snakes capture us like no other creature. As serpents, dragons, and ouroboroi, their potency as symbols complicates their objective portrayal. Meanwhile, research suggests that serpentine shapes are present as ciphers within our visual circuitry before we ever even see them. From traditions of natural history to present-day neurobiology, there may be no way to depict snakes that is not also deeply imaginary.

Transcriptome Analyses Reveal Circadian-Related Expression Features in the Visual Systems of Two Snakes

The visual characteristics of animals with different circadian habits, especially colubrid snakes, exhibit highly variable photoreceptor morphology. While studies have reported on the diversity in retinal cell morphology among snakes with different circadian patterns, few studies have examined the expression of genes related to vision. To explore gene expression patterns in the eyes between diurnal and nocturnal snakes, we carried out RNA sequencing of six tissues (eye, heart, liver, lung, kidney, and muscle) in two colubrids with disparate circadian activities, i.e., diurnal Ahaetulla prasina and nocturnal Lycodon flavozonatum, followed by weighted gene co-expression network analysis (WGCNA). The genes in the two most correlated modules were primarily enriched in different functional pathways, thus suggesting different biological functions. Three opsin genes (RH1, LWS, and SWS) were differentially expressed between the two species. Moreover, in the phototransduction pathway, different genes were highly expressed in the eyes of both species, reflecting specific expression patterns in the eyes of snakes with different circadian activity. We also confirmed the dominance of cone- and rod-related genes in diurnal and nocturnal adaptation, respectively. This work provides an important foundation for genetic research on visual adaptation in snakes and provides further insight into the adaptive evolution of such species.

Impact of various MRI signal intensity changes on radiological parameters, the neurological status, and surgical outcomes in degenerative cervical myelopathy

Study designA retrospective study of prospectively collected date. PurposeThe present study aimed to identify patient characteristics, radiological factors, the neurological status, and postoperative outcomes associated with MRI signal intensity changes in degenerative cervical myelopathy (DCM). Material and methodOne hundred and fourteen DCM patients who underwent posterior decompression surgeries were enrolled. Pre- and postoperative (12 months) Japanese Orthopedic Association (JOA) scores, cervical alignment and balance on X rays, the cross-sectional area of the spinal cord (CSA) in kinematic CT myelography (CTM). The recovery rate (RR) of the total JOA score and those specific for the upper and lower limb items were evaluated. MRI included T1-weighted imaging (WI) and T2WI. Patients were classified into two groups for a univariate analysis according to the presence or absence of a high signal intensity (HIS) in the sagittal view on T2WI, a low signal intensity (LSI) in the sagittal view on T1WI, the distribution of HSI at a single or multiple levels, and the presence or absence of the snake eye appearance. A multiple logistic regression analysis (MLRA) was performed to identify factors associated with signal intensity changes on MRI. ResultsNinety-six patients (84.3%) were classified into HIS changes in the sagittal view on T2WI. The group with multilevel HSI showed significantly lower RR specific for the lower extremity JOA score (30.8% vs 47.7%; P = 0.016). The snake eye-positive group showed a significantly inferior RR specific for the upper extremity JOA score (40.1% vs 53.2%; P = 0.04).In MLRA, LSI changes on T1WI revealed small CSAF (P = 0.02, Odds ratio; 0.77, 95%CI:0.61–0.97), while HSI changes on T2WI revealed a small CSAF (P = 0.008, Odds ratio;1.36, 95%CI:1.08–1.72) and large C2–7 angle during extension (P = 0.009, Odds ratio;0.73, 95%CI:0.58–0.92). CSAF correlated with multilevel HSI changes (P = 0.006, Odds ratio;0.78, 95%CI:0.66–0.93). The snake eye appearance correlated with CSAF (P = 0.006, Odds ratio;0.78, 95%CI:0.66–0.93) and the duration of disease (P = 0.05, Odds ratio;1.01, 95%CI:1.0–1.03). ConclusionSevere and poorly compensated spinal cord compression during neck flexion may cause signal intensity changes. The snake eye appearance may be useful as a sign of the inferior postoperative recovery of upper limb function, and multilevel HSI as a sign of the inferior postoperative recovery of lower limb function.

Snake Eye Appearance; A Rare Radiology Presentation in Acute Flaccid Paralysis: A Case Report

Background: Acute flaccid paralysis (AFP) is defined by the acute onset of weakness or paralysis with reduced muscle tone in children. There are many non-infectious and infectious causes. Snake eye appearance (SEA) is a rare radiologic appearance and helps narrow down differential diagnoses in flaccid paralysis. Case Presentation: Here, we reported a 6 months-old girl who was admitted with sudden onset flaccid paralysis. She was lethargic and ill without any detectable deep tendon reflexes. She had a high fever that had started 3 days earlier with malaise, poor feeding and coryza. The first child of the family was a boy who expired with similar symptoms; however, the reason is still unknown. Her parents were relatives (cousins). The laboratory and cerebrospinal fluid tests analysis were normal. The brain MRI analysis revealed T1 dim Hypo intensity and T2 hyperintensity along with obvious ADC map hyperintensity in the brain stem. At first, the PCR tests analysis of stool samples for poliovirus and enterovirus were normal. Spinal MRI showed snake eye appearance and helped us narrow our differential diagnosis. We repeated the PCR tests of stool because of snake eye appearance in cervical MRI that was positive for poliovirus and indicated vaccine-associated Paralytic Poliomyelitis (VAPP). Unfortunately, she expired from vaccine associated poliomyelitis. Conclusion: Snake eye appearance is a rare radiologic appearance that can be seen in several pathological conditions; however, it is very rare in patients with acute flaccid paralysis. Radiology signs, especially in spinal cord MRI, can help recognizing abnormalities in images, and narrow the list of differential diagnosis in acute flaccid paralysis. Therefore, spinal cord MRI has an important role in the evaluation of patient with brain stem involvement in acute flaccid paralysis.

Cervical transverse MRI in ALS diagnosis and possible link to VEGF and MMP9 single nucleotide polymorphisms. Case Report

We report the case of a patient diagnosed with ALS and presenting with a “snake eyes” sign on axial cervical MRI. Given the peculiar radiological presentation and our patient’s young age, we decided to perform a genetic analysis to better investigate the molecular mechanisms underlying the pathogenesis of his clinical phenotype. In our study, we identified different polymorphisms of interest at the level of VEGF and MMP9 promoters that we suggest could contribute to neuronal sufferance by promoting vascular abnormalities and tissue hypoxia, in accordance with previous published papers. When combined with repetitive mechanical stress at cervical level, as evident in our patient’s case, the resultant radiological image appears to be the “snake eyes” sign in the anterior horns of the cervical spinal cord, while the clinical phenotype is that of an atypical ALS case, possibly an ALS-mimic. To correctly identify and diagnose such patients, in particular when disease course and neuroradiological data do not correspond to those of a classical ALS case, we underline the importance of axial cervical MRI studies and suggest the possibility of their implementation into routine clinical practice.

Modeling and Prediction of Ride-Sharing Utilization Dynamics

The potential of an efficient ride-sharing scheme to significantly reduce traffic congestion, lower emission level, and drivers’ stress, as well as facilitating the introduction ofsmart citieshas been widely demonstrated in recent years. Furthermore, ride sharing can be implemented within a sound economic regime through the involvement of commercial services that creates a win-win for all parties (e.g.,Uber,LyftorSidecar). This positive thrust however is faced with several delaying factors, one of which is the volatility and unpredictability of the potential benefit (or utilization) of ride-sharing at different times, and in different places. Better understanding of ride-sharing dynamics can help policy makers and urban planners in increase the city’s “ride-sharing friendliness” either by designing new ride-sharing oriented systems, as well as by providing ride-sharing service operators better tools to optimize their services. In this work the following research questions are posed: (a) Is ride-sharing utilization stable over time or does it undergo significant changes? (b) If ride-sharing utilization is dynamic can it be correlated with some traceable features of the traffic? and (c) If ride-sharing utilization is dynamic can it be predicted ahead of time? We analyze a dataset of over 14 million taxi trips taken in New York City. We propose a dynamic travel network approach for modeling and forecasting the potential ride-sharing utilization over time, showing it to be highly volatile. In order to model the utilization's dynamics, we propose a network-centric approach, projecting the aggregated traffic taken from continuous time periods into a feature space comprised of topological features of the network implied by this traffic. This feature space is then used to model the dynamics of ride-sharing utilization over time. The results of our analysis demonstrate the significant volatility of ride-sharing utilization over time, indicating that any policy, design, or plan that would disregard this aspect and chose a static paradigm would undoubtably be either highly inefficient or provide insufficient resources. We show that using our suggested approach it is possible to model the potential utilization of ride sharing based on the topological properties of the rides network. We also show that using this method the potential utilization can be forecasting a few hours ahead of time. One anecdotal derivation of the latter is that perfectly guessing the destination of a New York taxi rider becomes nearly three times easier than rolling a “Snake Eyes” at a casino.

Snake Eyes, Charlene von Heyl, Deichtorhallen, Hamburg, 22 June–23 September 2018; Museum Dhondt-Dhaenens, Belgium, 14 October–13 January 2019; Hirschhorn Museum, Washington, DC, 8 November–27 January 2019

Snake Eyes, Charlene von Heyl, Deichtorhallen, Hamburg, 22 June–23 September 2018; Museum Dhondt-Dhaenens, Belgium, 14 October–13 January 2019; Hirschhorn Museum, Washington, DC, 8 November–27 January 2019

Study of the acute oral toxicity of methanol extract of aerial parts from Marsilea quadrifolia Linn

Marsilea quadrifolia Linn is a pteridophyte belonging to Family Marsileaceae commonly known as European water clover. M. quadrifolia is used to treat snake bite, cough, bronchitis, diabetes, psychiatric diseases, eye diseases, diarrhoea and skin diseases. Objective of the study is to identify a dose causing major adverse effects and an estimation of the minimum dose causing lethality, according to regulatory guidelines (OECD 425). Female Swiss Albino mice weighing 20-25 gm, aged 56 to 70 days were chosen for the study. Mice were divided into two groups (n=10/group). Group I served as control and treated with Saline. The Group II received methanol extract of M. quadrifolia orally ranging from 175 to 2000 mg/kg body weight by using oral feeding needle sleeved on to disposable syringe. They were kept in individual polypropylene cages provided with clean bedding of rice husk.. There was no mortality or behavioural changes observed in treated animals. All the animals belonging to the treated group survived throughout the 14 days observation period after dosing. The data revealed that LD50 of the extract was greater than 2000 mg/kg b.w. There was no significant variation found in body weight and organ to body mass index. In comparison with control group, there was significant increase in levels of ALT, AST,Bilirubin, total proteins, globulin levels, urea, cholesterol, triglycerides, LDL, platelet count, MCV, MCH, WBC count and lymphocytes whereas ALP and MCHC levels were reduced significantly. No significant changes were observed in HB, total RBC, total bilirubin, albumin. The methanol extract of aerial parts from Marsilea quadrifolia Linn had nontoxic effect on the biochemical and haematological parameters studied up to a dose of 2000 mg/kg. The lethal dose is therefore over 2000 mg/kg. Keywords: Marsilea quadrifolia, Methanol, Albino mice, Snake bite

Mid-term clinical outcomes of anterior cervical internal fixation and fusion for Hirayama disease

Objective To assess the mid-term clinical and radiological outcomes of anterior cervical internal fixation and fusion for the treatment of Hirayama disease and to evaluate the clinical significance and value of this procedure. Methods All of 31 patients underwent anterior cervical internal fixation and fusion were retrospectively analyzed with a minimum of 5 years follow-up in our hospital between May 2008 and May 2011, whose disease progressively deteriorated after six-month's conservative therapy (neck collar) preoperatively. There were 30 males and 1 female with an average age of 19.0±2.7 years which ranged from 16 to 27. The clinical outcomes included forearm and hand muscle atrophy and strength. The radiological outcomes included range of motion (ROM) of the whole cervical spine and unstable segments, as well as venous flow empty phenomena and snake eyes sign on MRI in the flexed position. All were recorded at 3 month, 1 year, 3 year and 5-6 years follow-up time points after surgery. The preoperative and postoperative quantitative variables were analyzed by paired t test, and a P<0.05 was used to indicate statistical significance. Results All the patients showed no further progression of symptoms of muscular weakness or atrophy. At the end of 5-6 years' follow-up, 24 of the 31 patients (77.4%) showed improved muscle strength and 16 of the 31 patients (51.6%) showed improved atrophy. Thirty-one patients had a forearm muscle strength of 4 to 5 at the last follow-up, with an average of 4.9±0.3, which was superior to preoperative 0 to 5 (3.6 ±1.0); grip strength was 3 to 5 kg, with an average of 3.9±0.7 kg, significanthigher than 1 to 3.8 kg (2.5±0.8 kg) before surgery. Score of muscle strength of the 31 patients at the end of 5-6 years' follow-up was 4.9±0.3 (4 to 5), which was significantly higher than preoperative. Postoperative X-rays at the end of 5-6 years' follow-up revealed that all the cases' internal fixation was at the proper position, and no losing or broken of the internal fixation were identified. Dynamic X-rays of cervical spine showed the range of motion (ROM) of the whole cervical spine was significantly decreased after the operation. The ROM of preoperation was 77.8°±12.7° and that of 5-6 years postoperation was 27.9°±7.6°. The unstable segments of cervical spine became stable postoperatively. The flexible position MRI of cervical spine showed the spinal cord was completely relieved, without new compression. Venous flow empty phenomena disappeared and no snake eyes sign was identified. Conclusion Anterior cervical internal fixation and fusion is an effective surgical treatment for Hirayama disease and may provide preferable mid-term clinical and radiological outcomes. This procedure has clinical significance and value in terms of control of the progression and outcome of this disease. Key words: Cervical vertebrae; Spinal cord compression; Upper extremity; Muscular atrophy; Spinal fusion