Tauchi Ryoji, Imagama Shiro, Inoh Hidefumi, Yukawa Yasutsugu, Kanemura Tokumi, Sato Koji, Matsubara Yuji, Harada Atsushi, Sakai Yoshihito, Hachiya Yudo, Kamiya Mitsuhiro, Yoshihara Hisatake, Ito Zenya, Ando Kei, Hirano Kenichi, Muramoto Akio, Matsui Hiroki, Matsumoto Tomohiro, Ukai Junichi, Kobayashi Kazuyoshi, Shinjo Ryuichi, Nakashima Hiroaki, Ishiguro Naoki
Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, 4668550, Japan.
Eur J Orthop Surg Traumatol. 2015 Jul;25 Suppl 1:S107-13. doi: 10.1007/s00590-014-1504-2. Epub 2014 Jul 5.
The purposes of this study were to evaluate the clinical outcome after surgical treatment of patients with the proximal type of cervical spondylotic amyotrophy (CSA) and to explore the appropriate timing for surgical intervention.
A retrospective review was performed on a consecutive cohort of 41 patients who underwent surgical treatment for the proximal type of CSA between 1995 and 2011 at the Nagoya Spine Group Hospitals. We collected information regarding age, type of muscle atrophy, preoperative and final manual muscle test, duration of symptoms, high-intensity areas on T2-weighted MRI images, low-intensity areas on T1-weighted MRI images, levels of spinal canal stenosis, the compression lesion site, cervical kyphosis and surgical procedures (laminoplasty, anterior spinal fusion and posterior spinal fusion). Univariate analyses and multivariate logistic regression analysis were performed to identify correlates of a poor outcome. To explore the appropriate timing for performing surgery, we analyzed the data using receiver operating characteristic (ROC) analysis.
The duration of CSA symptoms was 11.6 months on average. The surgical results were excellent for 25 patients, good for six, fair for nine and poor for one. On multivariate logistic regression analysis, the duration of symptoms was statistically associated with a poor surgical outcome (OR 1.393, p = 0.011). ROC analysis demonstrated that 4.3 months from the onset of CSA symptoms was the appropriate time to undergo surgery.
Our results indicate that we should recommend surgical intervention to patients with the proximal type of CSA within about 4 months after the onset of symptoms if conservative treatment has not been successful.
本研究旨在评估近端型颈椎病性肌萎缩（CSA）患者手术治疗后的临床疗效，并探讨合适的手术干预时机。
对1995年至2011年期间在名古屋脊柱集团医院接受近端型CSA手术治疗的41例连续患者进行回顾性研究。我们收集了有关年龄、肌肉萎缩类型、术前和最终徒手肌力测试、症状持续时间、T2加权MRI图像上的高强度区域、T1加权MRI图像上的低强度区域、椎管狭窄程度、压迫病变部位、颈椎后凸以及手术方式（椎板成形术、前路脊柱融合术和后路脊柱融合术）的信息。进行单因素分析和多因素逻辑回归分析以确定预后不良的相关因素。为了探讨进行手术的合适时机，我们使用受试者操作特征（ROC）分析对数据进行了分析。
CSA症状的平均持续时间为11.6个月。手术结果优25例，良6例，可9例，差1例。多因素逻辑回归分析显示，症状持续时间与手术预后不良在统计学上相关（OR 1.393，p = 0.011）。ROC分析表明，CSA症状出现后4.3个月是进行手术的合适时间。
我们的结果表明，如果保守治疗未成功，对于近端型CSA患者，我们应在症状出现后约4个月内建议其进行手术干预。
