Appropriate timing of surgical intervention for the proximal type of cervical spondylotic amyotrophy

Tauchi, Ryoji; Imagama, Shiro; Inoh, Hidefumi; Yukawa, Yasutsugu; Kanemura, Tokumi; Sato, Koji; Matsubara, Yumiko; Harada, Atsushi; Sakai, Yoshihito; Hachiya, Yudo; Kamiya, Mitsuhiro; Yoshihara, Hisatake; Ito, Zenya; Ando, Kei; Hirano, Ken‐ichi; Muramoto, Akio; Matsui, Hiroki; Matsumoto, Tomohiro; Ukai, Junichi; Shinjo, Ryuichi; Nakashima, Hiroaki; Ishiguro, Naoki

doi:10.1007/s00590-014-1504-2

Cited by 17 publications

(11 citation statements)

References 9 publications

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“…In their multivariate analysis, Tauchi et al [13] found that the symptom duration was a factor that affects the prognosis. According to the receiver operating characteristic analysis of a different study, Tauchi et al [15] recommended 4.3 months from symptom onset to surgery as the most appropriate timing with which to avoid an unfavorable postoperative course in patients with proximal type CSA. With respect to the preoperative physical status, the severity of the MMT grade and presence of long tract signs were related to poor recovery in some studies [5,13,15].…”

Section: Discussionmentioning

confidence: 99%

Cervical Spondylotic Amyotrophy: Case Series and Review of the Literature

et al. 2019

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ObjectiveCervical spondylotic amyotrophy (CSA) is a relatively rare entity caused by cervical degenerative spinal diseases and characterized by motor weakness accompanied by remarkable muscle atrophy in the upper extremities without significant sensory deficits or spastic paraparesis in the lower extremities. Postoperative outcomes and predictive prognostic factors vary among previous reports. In the present report, we describe the surgical results in patients who were surgically treated for CSA and present a literature review. MethodsIn total, 33 patients with CSA were retrospectively analyzed. Correlations between the surgical outcome and the following factors were statistically analyzed: age, sex, type of impaired muscle, preoperative severity of motor weakness, number of levels of cord or root compression, presence of a T2 high-intensity area in the spinal cord, cervical kyphosis, and methods of surgical procedure. ResultsOn postoperative neurological evaluation, 25 patients (75.8%) had favorable outcomes and 8 had unfavorable outcomes (proximal type, 72.2%; distal type, 78.6%). Patients with favorable outcomes were significantly younger than those with unfavorable outcomes (p=0.013). Patient’s characteristics except for age and radiological factors were not correlated to surgical outcome. ConclusionThe present study focused on the surgical results in patients who were surgically treated for CSA along with updated information from a literature review. Improvement of motor weakness is expected with acceptable prevalence although higher age can be a negative factor. Surgical outcomes and predictive factors related to a poor prognosis were determined and compared with those of previous articles.

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Section: Discussionmentioning

confidence: 99%

Cervical Spondylotic Amyotrophy: Case Series and Review of the Literature

et al. 2019

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“…Here we reviewed multiple MR-based (MR: T1, T2, T1 enahnced studies) prognostic factors for CSM patients undergoing spinal surgery [Tables 1 – 3 ]. [ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 ] The best/better outcomes correlated with Grade 0/Grade 1 MR changes on preoperative/postoperative MR studies, or trends toward improvement where postoperative T2 HCS regressed. [ 5 8 9 ] Poorer/worse prognoses correlated with HCS seen on all preoperative/postoperative MR scans, their failure to regress, documentation of cord re-expansion at sites of prior HCS, and residual triangular cord configurations.…”

Section: Discussionmentioning

confidence: 99%

“…Outcomes were correlated with patients undergoing anteiror cervical diskectomy/fusion (ACDF), anterior corpectomy/fusion (ACF), laminectomy with/without posterior fusion (LAM), and laminoplasty (LOP) [Tables 1 – 3 ; Figures 1 – 6 ]. [ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 ] Several Types/Grades helped assess the severity/prognostic import of low cord signals (LCS) and high cord signals (HCS) on preoperative/postoperative MR studies; Type/Grade 0: no/absent low cord signal (LCS), Type/Grade 1: faint/fuzzy/mild/obscure LCS; Grade 2: middle/intense/sharp HCS; and Type/Grade 3: mixed/HCS. [ 1 5 8 14 ] Additionally, the location/extent of HCS on T2 sagittal MR studies also impacted outcome and were defined as: focal (single level), multifocal (with skip areas), and/or multisegmental (MS: >1 level; continuous).…”

Section: Introductionmentioning

confidence: 99%

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High cord signals on magnetic resonance and other factors predict poor outcomes of cervical spine surgery: A review

Epstein¹

2018

Surg Neurol Int

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Background:High cord signals (HCS) on preoperative/postoperative T1, T1 gadolinium-diethylenetriaminepentaacetic acid (Gd-DTPA), and T2 magnetic resonance (MR) studies, postoperative failure of HCS to regress and/or cord re-expansion, and a triangular cord configuration are poor prognostic factors for surgical patients with cervical spondylotic myelopathy (CSM).Methods:Here, we reviewed the negative prognostic import of high Grades/Types and more extensive locations of preoperative/postoperative HCS on T1, T1 Gd-DTPA, and T2 MR studies in surgical patients with CSM. Additional predictors of poor operative outcomes included postoperative failure of HCS to regress, cord re-expansion at the site of a HCS, and the triangular vs. teardrop or boomerang cord configuration. The Types/Grades of HCS on MR follow:Type/Grade 0 – no/absent signal changes; Type/Grade 1 – mild/light/fuzzy/obscure/low cord signal (LCS) changes; Type/Grade 2 – sharp/intense/well-defined HCS; and Type/Grade 3 – mixed/HCS. The definitions of location/extent of LCS/HCS were: focal (1 level), multifocal (with skip areas), and multisegmental (continuous over >1 segment), while cord configuration was categorized as triangular, teardrop, or boomerang.Results:On MR studies, preoperative/postoperative Types/Grades 0–1 changes correlated with better prognoses (e.g., improved Japanese Orthopedic Association (JOA) scores or Nurick Grades), while Types/Grades 2–3 correlated with poorer outcomes. Multiple poor prognostic indicators also included; failure of postoperative HCS on MR to regress (particularly if multisegmental), postoperative cord re-expansion at the site of a prior HCS, and triangular cord configuration.Conclusions:Grade/Types 2–3 HCS on T1, T1 Gd-DTPA, and T2-weighted MR images on preoperative/postoperative MR studies, failure of HCS to regress (multisegmental), cord re-expansion at the site of a prior HCS, and a triangular cord configuration (atrophy) all contributed to poorer outcomes for CSM surgery.

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“…The appropriate surgical methods for CSA are controversial791214172627282930. Surgical approaches such as anterior cervical decompression and fusion or laminoplasty with or without foraminotomy have been advocated.…”

Section: Discussionmentioning

confidence: 99%

Predisposing factors for poor outcome of surgery for cervical spondylotic amyotrophy: a multivariate analysis

Zhang

Cui

Liu

et al. 2016

Sci Rep

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The purpose of this study was to characterize risk factors for poor surgical outcome in patients with cervical spondylotic amyotrophy (CSA). We retrospectively reviewed 88 cases of CSA surgery and investigated age, sex, duration of symptoms, atrophy type, preoperative muscle power, signal changes on MRI, anterior horn (AH) or ventral nerve root (VNR) compression, compression levels, surgical approach and postoperative recovery. Fifty (56.8%) patients had good surgical outcome. Logistic regression, with poor outcome as dependent variable, showed independent risks associated with duration of symptoms (OR; 1 for symptom duration less than 3 months versus 3.961 [95% CI; 1.203–13.039, p = 0.024] for symptom duration of 3–6 months versus 18.724 [95% CI; 3.967–88.367, p < 0.001] for symptom duration greater than 6 months), compression type (OR; 1 for VNR versus 4.931 [95% CI; 1.457–16.685, p = 0.010] for AH versus 5.538 [95% CI; 1.170–26.218, p = 0.031] for VNR + AH), and atrophy type (OR; 1 for proximal type versus 6.456 [95% CI; 1.938–21.508, p = 0.002] for distal type). These findings suggest that a long duration of symptoms, AH or both AH and VNR compression, and distal type are risk factors for poor surgical outcome in patients with CSA.

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Appropriate timing of surgical intervention for the proximal type of cervical spondylotic amyotrophy

Abstract: Our results indicate that we should recommend surgical intervention to patients with the proximal type of CSA within about 4 months after the onset of symptoms if conservative treatment has not been successful.

Cited by 17 publications

References 9 publications

Cervical Spondylotic Amyotrophy: Case Series and Review of the Literature

Cervical Spondylotic Amyotrophy: Case Series and Review of the Literature

High cord signals on magnetic resonance and other factors predict poor outcomes of cervical spine surgery: A review

Predisposing factors for poor outcome of surgery for cervical spondylotic amyotrophy: a multivariate analysis

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