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Gao Y, Sun C, Ma X, Lu F, Jiang J, Wang H. Do patients with Hirayama disease require surgical treatment? A review of the literature. Intractable Rare Dis Res 2022; 11:173-179. [PMID: 36457585 PMCID: PMC9709617 DOI: 10.5582/irdr.2022.01105] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/11/2022] [Accepted: 10/22/2022] [Indexed: 12/12/2022] Open
Abstract
The main clinic characteristic of Hirayama disease (HD) is atrophy of the distal muscles in the upper limbs. Recently, an increasing number of HD cases have been reported. Many HD patients have persistently progressive symptoms and conservative treatments failed. This article aims to review the current status of the field and summarizes the main surgical treatment options for patients with HD. A comprehensive search of the PubMed and the Web of Science databases was conducted from their inception to September 15th, 2022. Search terms included "juvenile muscular atrophy of upper extremity", "Hirayama disease" and "surgery". A total of 169 relevant publications were identified and 29 articles were finally reviewed. Current surgical treatments for HD are either anterior cervical surgery or posterior cervical surgery. The two approaches can effectively stop the disease. However, no studies have compared the advantages and limitations of the two surgical methods. The previous view that HD can be improved with conservative treatment has been challenged. In many studies, surgical treatment has been shown to improve the hand function in patients with HD. However, there is still controversy about the methods of anterior and posterior cervical surgery. Future research could focus on exploring the advantages and limitations of different surgeries.
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Affiliation(s)
- Yuan Gao
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Chi Sun
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaosheng Ma
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Feizhou Lu
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
- The Fifth People' s Hospital of Shanghai, Fudan University, Shanghai, China
| | - Jianyuan Jiang
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
- Address correspondence to:Hongli Wang and Jianyuan Jiang, Department of Orthopedics, Huashan Hospital, Fudan University, No.12, Wulumuqi Middle Road, Jing 'an District, Shanghai 200040, China. E-mail: (HW); (JJ)
| | - Hongli Wang
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
- Address correspondence to:Hongli Wang and Jianyuan Jiang, Department of Orthopedics, Huashan Hospital, Fudan University, No.12, Wulumuqi Middle Road, Jing 'an District, Shanghai 200040, China. E-mail: (HW); (JJ)
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Wang H, Tian Y, Wu J, Luo S, Zheng C, Sun C, Nie C, Xia X, Ma X, Lyu F, Jiang J, Wang H. Update on the Pathogenesis, Clinical Diagnosis, and Treatment of Hirayama Disease. Front Neurol 2022; 12:811943. [PMID: 35178023 PMCID: PMC8844368 DOI: 10.3389/fneur.2021.811943] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/24/2021] [Indexed: 11/29/2022] Open
Abstract
Hirayama disease (HD) is characterized by the juvenile onset of unilateral or asymmetric weakness and amyotrophy of the hand and ulnar forearm and is most common in males in Asia. A perception of compliance with previous standards of diagnosis and treatment appears to be challenged, so the review is to update on HD. First, based on existing theory, the factors related to HD includes, (1) cervical cord compression during cervical flexion, (2) immunological factors, and (3) other musculoskeletal dynamic factors. Then, we review the clinical manifestations: typically, (1) distal weakness and wasting in one or both upper extremities, (2) insidious onset and initial progression for 3-5 years, (3) coarse tremors in the fingers, (4) cold paralysis, and (5) absence of objective sensory loss; and atypically, (1) positive pyramidal signs, (2) atrophy of the muscles of the proximal upper extremity, (3) long progression, and (4) sensory deficits. Next, updated manifestations of imaging are reviewed, (1) asymmetric spinal cord flattening, and localized lower cervical spinal cord atrophy, (2) loss of attachment between the posterior dural sac and the subjacent lamina, (3) forward displacement of the posterior wall of the cervical dural sac, (4) intramedullary high signal intensity in the anterior horn cells on T2-weighted imaging, and (5) straight alignment or kyphosis of cervical spine. Thus, the main manifestations of eletrophysiological examinations in HD include segmental neurogenic damages of anterior horn cells or anterior roots of the spinal nerve located in the lower cervical spinal cord, without disorder of the sensory nerves. In addition, definite HD needs three-dimensional diagnostic framework above, while probable HD needs to exclude other diseases via "clinical manifestations" and "electrophysiological examinations". Finally, the main purpose of treatment is to avoid neck flexion. Cervical collar is the first-line treatment for HD, while several surgical methods are available and have achieved satisfactory results. This review aimed to improve the awareness of HD in clinicians to enable early diagnosis and treatment, which will enable patients to achieve a better prognosis.
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Affiliation(s)
- Hongwei Wang
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
- Spine Center Fudan University, Shanghai, China
| | - Ye Tian
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
- Spine Center Fudan University, Shanghai, China
| | - Jianwei Wu
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
- Spine Center Fudan University, Shanghai, China
| | - Sushan Luo
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Chaojun Zheng
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
- Spine Center Fudan University, Shanghai, China
| | - Chi Sun
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
- Spine Center Fudan University, Shanghai, China
| | - Cong Nie
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
- Spine Center Fudan University, Shanghai, China
| | - Xinlei Xia
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
- Spine Center Fudan University, Shanghai, China
| | - Xiaosheng Ma
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
- Spine Center Fudan University, Shanghai, China
| | - Feizhou Lyu
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
- Spine Center Fudan University, Shanghai, China
- Department of Orthopedics, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Jianyuan Jiang
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
- Spine Center Fudan University, Shanghai, China
| | - Hongli Wang
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
- Spine Center Fudan University, Shanghai, China
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Antonioni A, Fonderico M, Granieri E. Hirayama Disease: A Case of an Albanian Woman Clinically Stabilized Without Surgery. Front Neurol 2020; 11:183. [PMID: 32256441 PMCID: PMC7090124 DOI: 10.3389/fneur.2020.00183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 02/25/2020] [Indexed: 11/15/2022] Open
Abstract
Hirayama Disease (HD) is a rare clinical condition that usually affects young people with preference for Asian males. It appears with unilateral distal amyotrophy or asymmetric bilateral amyotrophy of an upper limb which is to refer to an involvement of the spinal metamers C7-C8-T1. A clinical case of a female patient of Albanian nationality is described, with onset of the disease in adulthood and clinical and electrophysiological features suggestive of HD, without any characteristic imaging findings. Clinical investigations, EMG and radiological data facilitated the diagnosis and allowed the exclusion of degenerative forms of the motor neuron and radiculopathies. In this paper, we want to point out that the diagnosis of this pathology should be hypothesized even in the absence of characteristic epidemiological and imaging data.
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Affiliation(s)
- Annibale Antonioni
- Section of Neurology, Psychology and Psychiatry, Department of Biomedical and Specialty-Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Mattia Fonderico
- Section of Neurology, Psychology and Psychiatry, Department of Biomedical and Specialty-Surgical Sciences, University of Ferrara, Ferrara, Italy.,Department of Neuroscience, Firenze, Italy
| | - Enrico Granieri
- Section of Neurology, Psychology and Psychiatry, Department of Biomedical and Specialty-Surgical Sciences, University of Ferrara, Ferrara, Italy
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