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Increased Cervical Spinal Instability is Associated With the Development of Proximal-type Cervical Spondylotic Amyotrophy. Spine (Phila Pa 1976) 2022; 47:938-943. [PMID: 34923546 DOI: 10.1097/brs.0000000000004314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 12/10/2021] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES We aimed to clarify the clinical relationship between the etiology of proximal-type cervical spondylotic amyotrophy (CSA) and cervical sagittal alignment and instability. SUMMARY OF BACKGROUND DATA Although several researchers have discussed hypotheses regarding the etiology of CSA, the trigger and mechanism underlying the onset remain unclear. METHODS We retrospectively analyzed 52 proximal-type CSA patients (CSA group) and 60 control patients (Control group). The following data were collected: age; sex; cervical lordosis (CL); T1 slope (TS); TS-CL; C2-7 sagittal vertical axis (SVA) on x-ray in the neutral position; flexion angle; extension angle and range of motion (ROM) of C3/4, C4/5 and C5/6; and C3/4, C4/5 and C5/6 instability (translation of >3 mm for adjacent segmental segments) on dynamic x-ray. RESULTS Compared with the Control group, the CSA group was associated with an older age (mean age, 67.6 vs. 61.1 years' old, P= 0.029) and male sex (78.8% vs. 50.0%, P= 0.002). In the CSA group, the radiographic parameters showed smaller C4/5 and C5/6 extension angles and C5/6 ROM values and a greater C3/4 flexion angle than the Control group. Furthermore, compared with the Control group, the CSA group was associated with C3/4 instability (13.5% vs. 3.3%, P= 0.049) and C4/5 (21.2% vs. 3.3%, P = 0.003). A logistic regression analysis, with adjusting for the age and sex, showed that the C3/4 flexion angle (odds ratio [OR], 1.2; 95% confidence interval [CI], 1.08- 1.40, P =0.002), C3/4 instability (OR, 7.3; 95% CI 1.25-42.96, P =0.027) and C4/5 instability (OR, 8.1; 95% CI, 1.56-42.19, P = 0.012) were independent risk factors of CSA. CONCLUSION This study suggested that a wide C3/4 flexion angle and high C3/4 or C4/5 spinal instability were closely associated with the etiology of proximal-type CSA.
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Idiculla PS, Govindarajan R. A Case of Cervical Spondylotic Amyotrophy Mimicking Amyotrophic Lateral Sclerosis. Case Rep Neurol 2020; 12:314-320. [PMID: 33082770 PMCID: PMC7548943 DOI: 10.1159/000509684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 06/21/2020] [Indexed: 11/21/2022] Open
Abstract
Cervical spondylotic amyotrophy (CSA) is a rare clinical condition characterized by weakness and atrophy of the upper limb with minimal to no associated sensory deficits. The detection of the disease is based on clinical features at presentation, neurological examination, electrophysiological studies, and imaging. The proposed pathophysiological mechanisms include selective damage to the ventral root or anterior horn cells of the spinal cord. Depending on the muscle groups that are involved, CSA is broadly classified into a proximal type and a distal type. The clinical profiles of patients with CSA and ALS have a very close resemblance to each other, especially at the early stages of the disease. Cervical spine magnetic resonance imaging (MRI) may show T2 hyperintensity in both proximal and distal types. Electromyogram demonstrates denervation potentials and reduced motor unit potentials in the affected muscles. The conservative management is often the first-line modality, and those who fail to respond to conservative treatment have severe muscular atrophy and weakness, and distal-type CSA are considered potential candidates for surgery. We present the case of a 57-year-old female who presented with a 1-year history of left-hand weakness and wasting with no sensory deficits. She denied any involvement of her other hand or bilateral lower limbs, and she was referred to our clinic with the potential diagnosis of amyotrophic lateral sclerosis (ALS). An elaborate history, physical examination, electrophysiological studies, and imaging assisted us in reaching the diagnosis of CSA, 1 year after the onset of symptoms.
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Yamada T, Yoshii T, Ushio S, Taniyama T, Hirai T, Inose H, Sakai K, Shindo S, Arai Y, Okawa A. Surgical outcomes for distal-type cervical spondylotic amyotrophy: a multicenter retrospective analysis of 43 cases. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:2333-2341. [PMID: 31290024 DOI: 10.1007/s00586-019-06060-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 06/07/2019] [Accepted: 07/01/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Distal-type cervical spondylotic amyotrophy (CSA) is a rare form of cervical spondylosis that causes muscle weakness of upper extremities. The pathophysiology and appropriate surgical method for the treatment of CSA are still controversial. We investigated clinical outcomes in surgically treated distal-type CSA. METHODS The authors executed an analysis of the outcomes of 43 consecutive spinal surgeries performed in distal-type CSA patients. The duration of symptoms, perioperative manual muscle test (MMT) results, radiological findings, and perioperative complications were reviewed. We compared surgical outcomes between different approaches and examined the factors related to poor outcomes (MMT improvement ≤ 0) after surgery. RESULTS The pathophysiology of CSA was mostly caused by a combination of multiple lesions in the anterior horn and/or nerve root. Nineteen of 29 patients (65.5%) who received anterior approach methods were included in the good outcome group (MMT improvement ≥ 1), whereas 7 of 14 patients (50.0%) in the posterior group were classified as good. In the anterior group, the mean MMT grade significantly improved from 2.6 to 3.4 (p = 0.0035) despite the higher rate of complications. The duration of symptoms was substantially associated with poor outcomes. The MMT grade significantly improved from 2.2 to 3.2 (p = 0.0118) in the < 6 months group. Cervical alignments and preoperative MMT grade were not statistically associated with poor outcomes. CONCLUSIONS Patients with poor outcomes had symptoms for a longer duration. We found tolerable clinical outcomes within 6 months from onset. The anterior approaches might be recommended because this procedure significantly improved MMT levels in the hands. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Tsuyoshi Yamada
- Department of Orthopaedic Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchi-city, Saitama, 332-8558, Japan.,TMDU Spine Group, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Toshitaka Yoshii
- Department of Orthopaedic Surgery, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan. .,TMDU Spine Group, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
| | - Shuta Ushio
- Department of Orthopaedic Surgery, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.,TMDU Spine Group, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Takashi Taniyama
- Department of Orthopaedic Surgery, Kudanzaka Hospital, 1-6-12 Kudan-minami, Chiyoda-ku, Tokyo, 102-0074, Japan.,TMDU Spine Group, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Takashi Hirai
- Department of Orthopaedic Surgery, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.,TMDU Spine Group, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Hiroyuki Inose
- Department of Orthopaedic Surgery, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.,TMDU Spine Group, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Kenichiro Sakai
- Department of Orthopaedic Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchi-city, Saitama, 332-8558, Japan.,TMDU Spine Group, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Shigeo Shindo
- Department of Orthopaedic Surgery, Kudanzaka Hospital, 1-6-12 Kudan-minami, Chiyoda-ku, Tokyo, 102-0074, Japan.,TMDU Spine Group, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Yoshiyasu Arai
- Department of Orthopaedic Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchi-city, Saitama, 332-8558, Japan.,TMDU Spine Group, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Atsushi Okawa
- Department of Orthopaedic Surgery, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.,TMDU Spine Group, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
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Cervical spondylotic amyotrophy: a systematic review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:2293-2301. [PMID: 31037421 DOI: 10.1007/s00586-019-05990-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 02/22/2019] [Accepted: 04/22/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE Cervical spondylotic amyotrophy (CSA) is characterized by upper limb muscle weakness and atrophy, without sensory deficits. The pathophysiology of CSA has been attributed to selective injury to the ventral nerve root and/or anterior horn of the spinal cord. This review aimed to delineate the history of CSA and to describe the epidemiology, etiology, pathophysiology, classification, clinical features, radiological and electrophysiological assessment, diagnosis, differential diagnosis, natural history and treatment of CSA. METHODS A comprehensive search of PubMed, EMBASE, Cochrane library and Web of Science databases was conducted, from their inception to April 3, 2018. RESULTS Clinically, CSA is classified into three types: a proximal-type (involving the scapular muscles, deltoid and biceps), a distal-type (involving the triceps and muscles of the forearm and hand) and a diffuse-type (involving features of both the distal- and proximal-type). Diagnosis requires documentation of muscle atrophy, without significant sensory deficits, supported by careful neurological, radiological and neurophysiological assessments, with amyotrophic lateral sclerosis, Parsonage-Turner syndrome, rotator cuff tear and Hirayama disease being the principle differential diagnoses. Conservative management of CSA includes cervical traction, neck immobilization and physical therapy, with vitamin B12 or E administration being useful in some patients. Surgical treatment, including anterior decompression and fusion or laminoplasty, with or without foraminotomy, is indicated after conservative treatment failure. Factors associated with a poor outcome include the distal-type CSA, long symptom duration, older age and greater preoperative muscle weakness. CONCLUSION Although the disease process of CSA is self-limited, treatment remains challenging, leaving scope for future studies. These slides can be retrieved under Electronic Supplementary Material.
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