Could anterior cervical fixation be an alternative method in the management of Hirayama disease?

Abstract

The study aimed to evaluate the clinical efficacy and feasibility of surgical treatment for Hirayama disease(HD) by anterior cervical fixation(ACF). From August 2008 to November 2015, 13 patients(12 males and 1 female, average age, 16.3 ± 1.1 years) with HD underwent ACF. Surgery-related indexes, clinical efficacy, and radiographic parameters were used to evaluate the clinical outcomes of surgery. The surgery duration time range from 67 to 128 min(average 89.2 ± 19.9 min)and the blood loss range from 40 to 120 ml(average 68.1 ± 26.3 ml). Four patients got resolved tremor, and the other patients stopped progressing. Grip strength significantly improved from preoperative 15.6 ± 1.7 kilogram to postoperative 18.6 ± 1.9 kilogram(P < 0.001). The cross-sectional areas of the spinal cord at C6 and C7 levels increased from 0.7 ± 0.1 cm2 to 0.8 ± 0.1 cm2(P = 0.018) and from 0.6 ± 0.2 cm2 to 0.7 ± 0.1 cm2(P = 0.049) respectively. The cervical lordosis increased from 2.4 ± 3.4° to 7.0 ± 3.5°(P = 0.001). The range of cervical flexion was significantly decreased from preoperative 31.3 ± 11.5° to postoperative 14.3 ± 7.5°(P < 0.001). No surgical related complications such as hoarseness, cerebral fluid leakage, and surgical site infection were observed after surgery. Two patients, felt abnormal sensation of throat occasionally, showed screw loosening and internal fixators were removed finally. Athough screw loosening was observed, ACF could serve as an effective treatment in the management of the HD.