Cervical Spondylotic Amyotrophy Treated by Anterior Decompression-Three Case Reports-

Abstract

Cervical spondylotic amyotrophy (CSA) is a rare type of cervical spondylotic disorder. The surgical treatment of CSA is controversial. We treated three patients with the proximal type of CSA by anterior decompression. Three men (65, 61, and 58 years old) presented with CSA manifesting as unilateral muscle weakness and atrophy in the deltoid and biceps muscles without significant sensory deficit. Preoperative neuroradiological examinations revealed anterolateral spinal cord compression in one patient and ventral root compression in two patients at the C4-5 and C5-6 spaces. Magnetic resonance (MR) imaging showed no abnormal intramedullary signal intensity in any patient. Vertebrotomy deviated to the lesion side was performed to provide a better view of the laterally situated osteophytes. Anterior decompression was focused on the paramedial to lateral area, and further foraminotomy was performed according to the radiological findings. After decompression, intervertebral instrumentation was performed using titanium cervical cages. Two of the patients had good recovery of motor strength and one had moderate recovery despite persistent motor atrophy. Surgical intervention is effective in patients with CSA despite severe muscle atrophy unless MR imaging shows the presence of severe degenerative intramedullary lesion.

Cervical spondylotic amyotrophy

“…After an initial progressive course, the symptoms usually stabilize for years. The occurrence of cervical spondylotic amyotrophy is not correlated strictly to the severity of spondylotic changes [22,31,37,38]. Cervical spine MRI may reveal abnormal T 2 hyperintense change in the cervical cord [23], but such change is not constant [37].…”

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

“…Uchida et al [5] reported that, even in patients with the proximal type of atrophy, a long preoperative period of symptoms and medial compression of the spinal cord correlated with poor improvement in muscle power. Mori et al [3] demonstrated that the interval between onset and treatment was less than 3 months in the patients who made a good recovery, but was 18 months in the patient who did not recover well on three cases with the proximal type of CSA. Similarly, in the present study, we demonstrated that the clinical status of the proximal type of CSA before surgery, that is, a longer duration of symptoms and lower preoperative MMT grades, significantly influenced the surgical outcome.…”

“…Based on our results, we believe that physicians should recommend surgical intervention to patients with the proximal type of CSA within about 4 months of the onset of symptoms if conservative treatment has not been successful. Several authors of previous literature about CSA demonstrated risk factors for surgical outcome of CSA [2][3][4][5]. Uchida et al [5] reported that, even in patients with the proximal type of atrophy, a long preoperative period of symptoms and medial compression of the spinal cord correlated with poor improvement in muscle power.…”

“…However, several studies have found a significant association between a long preoperative period of symptoms and a poor surgical outcome [2][3][4][5]. Thus, the appropriate timing for surgery in CSA patients is still unclear.…”

Conservative treatment with hyperbaric oxygen therapy for cervical spondylotic amyotrophy

“…9,12,15,16 In addition, findings of electromyography are observed only in the atrophic muscles in case of CSA, but are diffuse in patients with ALS. 15 An important factor favoring CSA is the lack of bulbar muscle involvement and the non-progressive nature of motor symptoms and signs that are restricted to a few myotomes. HBO, which is widely performed for patients in hypoxic condition, is an attractive method of treatment that has frequently been used for several neurological diseases.…”