Dissociated Motor Loss in the Upper Extremities

Matsunaga, Shunji; Sakou, Takashi; Imamura, Takeshi; Morimoto, Norio

doi:10.1097/00007632-199310001-00007

Cited by 39 publications

(34 citation statements)

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“…Motor loss in the arms without myelopathy has been reported by several authors [12,20,40], but this has not been objectively measured. Few studies have shown the occurrence of specific symptoms after surgery.…”

Section: Discussionmentioning

confidence: 97%

Cervical radiculopathy: Pain, muscle weakness and sensory loss in patients with cervical radiculopathy treated with surgery, physiotherapy or cervical collar A prospective, controlled study

et al. 1997

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This prospective, randomised study compares the efficacy of surgery, physiotherapy and cervical collar with respect to pain, motor weakness and sensory loss in 81 patients with long-lasting cervical radiculopathy corresponding to a nerve root that was significantly compressed by spondylotic encroachment, with or without an additional bulging disk, as verified by MRI or CT-myelography. Pain intensity was registered on a visual analogue scale (VAS), muscle strength was measured by a hand-held dynamometer, Vigorometer and pinchometer. Sensory loss and paraesthesia were recorded. The measurements were performed before treatment (control 1), 4 months after the start of treatment (control 2) and after a further 12 months (control 3). A healthy control group was used for comparison and to test the reliability of the muscle-strength measurements. The study found that before start of treatment the groups were uniform with respect to pain, motor weakness and sensory loss. At control 2 the surgery group reported less pain, less sensory loss and had better muscle strength, measured as the ratio of the affected side to the non-affected side, compared to the two conservative treatment groups. After a further year (control 3), there were no differences in pain intensity, sensory loss or paraesthesia between the groups. An improvement in muscle strengths, measured as the ratio of the affected to the non-affected side, was seen in the surgery group compared to the physiotherapy group in wrist extension, elbow extension, shoulder abduction and internal rotation, but there were no differences in the ratios between the collar group and the other treatment groups. With respect to absolute muscle strength of the affected sides, there were no differences at control 1. At control 2, the surgery group performed somewhat better than the two other groups but at control 3 there were no differences between the groups. We conclude that pain intensity, muscle weakness and sensory loss can be expected to improve within a few months after surgery, while slow improvement with conservative treatments and recurrent symptoms in the surgery group make the 1-year results about equal.

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Section: Discussionmentioning

confidence: 97%

Cervical radiculopathy: Pain, muscle weakness and sensory loss in patients with cervical radiculopathy treated with surgery, physiotherapy or cervical collar A prospective, controlled study

et al. 1997

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“…Difficulty in shoulder abduction, positive arm-drop sign, or positive wrist-drop sign is always found in patients with cervical spondylotic amyotrophy [30,46]. Recently, Ahdab et al [2] reported that a 65-year-old man with cervical spondylotic amyotrophy was referred for a dropped head syndrome because posterior neck and shoulder girdle muscles were atrophic.…”

Section: Clinical Presentationmentioning

confidence: 99%

“…The proximal-type patients have muscular atrophy in the C5 and C6 myotomes [3,19,22,25,30,38], whereas patients with the distal-type amyotrophy have muscular atrophy in C7, C8, and Th1, with muscular atrophy distributed to the forearm and intrinsic muscles. In one study of 16 proximal-type patients and 15 distal-type patients, the distal-type patients often presented cold paresis and/or postural finger tremor, and none of distal-type patients had extension of atrophy to the proximal muscles during a long course of their illness.…”

Section: Classificationmentioning

confidence: 99%

“…Also, the methods of operative treatment for cervical spondylotic amyotrophy are still controversial. Anterior decompression and fusion [38] or laminoplasty with or without foraminotomy [30] has been reported. Some authors believe [8,20,21,36] that anterior decompression with or without medial foraminotomy is important for eliminating the anterior and/or anterolateral lesion, whereas some [5,14] advocate posterior laminoplasty with keyhole foraminotomy.…”

Section: Treatmentmentioning

confidence: 99%

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Cervical spondylotic amyotrophy

Jiang

Dai

2010

Eur Spine J

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Cervical spondylotic amyotrophy is characterized with weakness and wasting of upper limb muscles without sensory or lower limb involvement. Two different mechanisms have been proposed in the pathophysiology of cervical spondylotic amyotrophy. One is selective damage to the ventral root or the anterior horn, and the other is vascular insufficiency to the anterior horn cell. Cervical spondylotic amyotrophy is classified according to the most predominantly affected muscle groups as either proximaltype (scapular, deltoid, and biceps) or distal-type (triceps, forearm, and hand). Although cervical spondylotic amyotrophy always follows a self-limited course, it remains a great challenge for spine surgeons. Treatment of cervical spondylotic amyotrophy includes conservative and operative management. The methods of operative management for cervical spondylotic amyotrophy are still controversial. Anterior decompression and fusion or laminoplasty with or without foraminotomy is undertaken. Surgical outcomes of distal-type patients are inferior to those of proximal-type patients.

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“…1,9,10,17) The clinical characteristics, electrophysiological findings, and neuroradiological findings of CSA have been well documented. 7,12,13) CSA can be divided into two types according to the affected muscles in the upper limb.…”

Section: Introductionmentioning

confidence: 99%

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

Mori

Yamamoto

Nakao

et al. 2006

Neurol. Med. Chir.(Tokyo)

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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.

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Dissociated Motor Loss in the Upper Extremities

Cited by 39 publications

References 0 publications

Cervical radiculopathy: Pain, muscle weakness and sensory loss in patients with cervical radiculopathy treated with surgery, physiotherapy or cervical collar A prospective, controlled study

Cervical radiculopathy: Pain, muscle weakness and sensory loss in patients with cervical radiculopathy treated with surgery, physiotherapy or cervical collar A prospective, controlled study

Cervical spondylotic amyotrophy

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

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