Takahashi Toshiyuki, Hanakita Junya, Minami Manabu, Tomita Yosuke, Sasagasako Tomoki, Kanematsu Ryo
Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Fujieda, Japan.
Neurospine. 2019 Sep;16(3):579-588. doi: 10.14245/ns.1938210.105. Epub 2019 Sep 30.
Cervical spondylotic amyotrophy (CSA) is a relatively rare entity caused by cervical degenerative spinal diseases and characterized by motor weakness accompanied by remarkable muscle atrophy in the upper extremities without significant sensory deficits or spastic paraparesis in the lower extremities. Postoperative outcomes and predictive prognostic factors vary among previous reports. In the present report, we describe the surgical results in patients who were surgically treated for CSA and present a literature review.
In total, 33 patients with CSA were retrospectively analyzed. Correlations between the surgical outcome and the following factors were statistically analyzed: age, sex, type of impaired muscle, preoperative severity of motor weakness, number of levels of cord or root compression, presence of a T2 high-intensity area in the spinal cord, cervical kyphosis, and methods of surgical procedure.
On postoperative neurological evaluation, 25 patients (75.8%) had favorable outcomes and 8 had unfavorable outcomes (proximal type, 72.2%; distal type, 78.6%). Patients with favorable outcomes were significantly younger than those with unfavorable outcomes (p=0.013). Patient's characteristics except for age and radiological factors were not correlated to surgical outcome.
The present study focused on the surgical results in patients who were surgically treated for CSA along with updated information from a literature review. Improvement of motor weakness is expected with acceptable prevalence although higher age can be a negative factor. Surgical outcomes and predictive factors related to a poor prognosis were determined and compared with those of previous articles.
脊髓型颈椎病性肌萎缩(CSA)是一种相对罕见的由颈椎退行性脊柱疾病引起的病症,其特征为上肢运动无力并伴有明显的肌肉萎缩,而无明显感觉障碍或下肢痉挛性轻瘫。既往报道中手术结果及预测预后因素各不相同。在本报告中,我们描述了接受CSA手术治疗患者的手术结果并进行文献综述。
对33例CSA患者进行回顾性分析。对手术结果与以下因素之间的相关性进行统计学分析:年龄、性别、受累肌肉类型、术前运动无力严重程度、脊髓或神经根受压节段数、脊髓T2高信号区的存在、颈椎后凸以及手术方式。
术后神经功能评估显示,25例患者(75.8%)预后良好,8例预后不佳(近端型,72.2%;远端型,78.6%)。预后良好的患者明显比预后不佳的患者年轻(p=0.013)。除年龄和影像学因素外,患者的其他特征与手术结果无关。
本研究聚焦于接受CSA手术治疗患者的手术结果,并结合文献综述的最新信息。尽管年龄较大可能是一个不利因素,但预计运动无力仍能得到改善且发生率可接受。确定了与预后不良相关的手术结果及预测因素,并与以往文章中的结果进行了比较。