Conservative treatment with hyperbaric oxygen therapy for cervical spondylotic amyotrophy

Abstract

Study design: Small case series of patients with cervical spondylotic amyotrophy (CSA) managed by conservative treatment with hyperbaric oxygen (HBO) therapy. Objective: To study the effects of conservative treatment with HBO therapy of CSA patients. Setting: Department of Orthopaedic Surgery, Imakiire General Hospital, Kagoshima, Japan. Methods: 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. Results: 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. Conclusion: 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.

A Case of Cervical Spondylotic Amyotrophy Mimicking Amyotrophic Lateral Sclerosis

“…The distal type affects the triceps, forearm muscles, and intrinsic hand muscles; from involvement at the C7-T1 segments [ 3 ]. A diffuse form has also been explained which involves atrophy of both proximal and distal muscles [ 6 ]. Occasionally, sensory disturbances in the upper extremities or hyperreflexia in the lower limbs has been found in these patients [ 7 ].…”

Factors associated with an excellent outcome after conservative treatment for patients with proximal cervical spondylotic amyotrophy using electrophysiological, neurological and radiological findings

“…The clinical outcomes of cervical traction, immobilization of the neck using a collar, physical therapy, administration of vitamin B12, injection of prostaglandin E1 (IPE), and hyperbaric oxygen (HBO) as conservative treatments have been reported. [4][5][6][7][8] Tofuku et al reported that HBO may facilitate the recovery of reversibly injured anterior cells by improving the hypoxic condition of neural tissue at risk, although it had no effect on the recovery of irreversibly injured anterior cells. 5 Shibuya et al suggested that patients with anterior spinal artery syndrome may have been included among those diagnosed with CSA and reported good outcomes after IPE.…”

“…There have been few reports on the outcomes of conservative management for proximal CSA. [4][5][6][7][8] It is still unclear how these patients recover shoulder abduction and elbow flexion. We collected data on patient age; duration of clinical history (DCH); and electrophysiological, radiological, and neurological findings.…”

Revisiting the spectrum of lower motor neuron diseases with snake eyes appearance on magnetic resonance imaging

“…Treatments targeting vascular insufficiency have been suggested recently for cervical spondylotic amyotrophy. In a recent uncontrolled study, it has been suggested that hyperbaric oxygen therapy might improve the outcome of anterior horns ischaemia in new onset cervical spondylotic amyotrophy . However, the utility of these approaches remains to be confirmed.…”