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

Inui, Yoshihiro; Miyata, Hiroshi; Sumi, Masatoshi; Uno, Koki

doi:10.1097/brs.0b013e3181e531a1

Cited by 31 publications

(27 citation statements)

References 11 publications

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“…Therefore, based on our results, it was considered that the presence of the pyramidal tract sign can be used as a poor prognostic factor in surgically treated CSA patients. However, Inui et al 11 reported that the pyramidal tract sign was not associated with the prognosis, not only in conservatively treated patients, but also in surgically treated patients. Although further investigations will be needed to explain the inconsistencies between the studies, the differences in the regimen used for conservative management may be at least partly responsible.…”

Section: Discussionmentioning

confidence: 99%

Prognostic factors for cervical spondylotic amyotrophy: are signs of spinal cord involvement associated with the neurological prognosis?

Iizuka

Mieda

et al. 2014

Spinal Cord

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Objectives: The purpose of this study was to clarify the prognostic factors for cervical spondylotic amyotrophy (CSA). Methods: The authors retrospectively reviewed the medical records of 47 consecutive patients with CSA in whom the presence/ absence of the pyramidal tract sign was noted. We analyzed whether the age, sex, presence of diabetes mellitus, medication (vitamin B12), type of the most atrophic and impaired muscle, the muscle strength at the presentation, the presence of the pyramidal tract sign, magnetic resonance imaging (MRI) findings, including the presence and number of T2 high signal intensity areas (T2 HIA) in the spinal cord and the conversion to surgery were associated with the recovery of muscle strength in the patients. In addition, we also investigated whether the duration of symptoms before surgery and the type of surgery were associated with the recovery of muscle strength in patients who required conversion to surgical treatment. Results: The presence of T2 HIA on MRI (P ¼ 0.002), the number of T2 HIA on MRI (P ¼ 0.002) and conversion to surgery (P ¼ 0.015) were found to be significantly associated with a poorer recovery at the observational final follow-up. Further, the presence of the pyramidal tract sign (P ¼ 0.043) was significantly associated with a poor recovery at the final follow-up after surgery. Conclusion: The presence of a high signal intensity change on T2-weighted MRI and the pyramidal tract sign can be used as prognostic factors for patients with CSA.

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Section: Discussionmentioning

confidence: 99%

Prognostic factors for cervical spondylotic amyotrophy: are signs of spinal cord involvement associated with the neurological prognosis?

Iizuka

Mieda

et al. 2014

Spinal Cord

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“…However, we found no significant differences in the course of disease and high intensity zone on the T2-weighted MRI between the two types. Similarly, Inui et al 16. found no statistical difference in surgical outcomes between disease types and sites of compression.…”

Section: Discussionmentioning

confidence: 93%

Evaluation of characteristics and surgical outcomes in cervical spondylotic amyotrophy

Wang

Jiang

et al. 2014

IJOO

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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.

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“…First, symptoms in some patients with the proximal type of CSA have resolved spontaneously or with conservative treatment such as neck traction, which allowed the patients to avoid invasive treatment. Secondly, there is a possibility that these patients may actually have a motor neuron disease such as ALS, and treating [7] reported that patients who fulfilled predictive factors such as age \50 years old, duration of symptoms \6 months, single-level stenosis, foraminal stenosis and a good response to traction therapy improved with conservative treatment. On the other hand, other studies reported that conservative treatment may be effective, but complete resolution cannot be expected [2,8,9].…”

Section: Discussionmentioning

confidence: 98%

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

Tauchi

Imagama

Inoh

et al. 2014

Eur J Orthop Surg Traumatol

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

Cited by 31 publications

References 11 publications

Prognostic factors for cervical spondylotic amyotrophy: are signs of spinal cord involvement associated with the neurological prognosis?

Prognostic factors for cervical spondylotic amyotrophy: are signs of spinal cord involvement associated with the neurological prognosis?

Evaluation of characteristics and surgical outcomes in cervical spondylotic amyotrophy

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

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