Abstract
Objectives:
The purpose of this study was to clarify the prognostic factors for cervical spondylotic amyotrophy (CSA).
Methods:
The authors retrospectively reviewed the medical records of 47 consecutive patients with CSA in whom the presence/absence of the pyramidal tract sign was noted. We analyzed whether the age, sex, presence of diabetes mellitus, medication (vitamin B12), type of the most atrophic and impaired muscle, the muscle strength at the presentation, the presence of the pyramidal tract sign, magnetic resonance imaging (MRI) findings, including the presence and number of T2 high signal intensity areas (T2 HIA) in the spinal cord and the conversion to surgery were associated with the recovery of muscle strength in the patients. In addition, we also investigated whether the duration of symptoms before surgery and the type of surgery were associated with the recovery of muscle strength in patients who required conversion to surgical treatment.
Results:
The presence of T2 HIA on MRI (P=0.002), the number of T2 HIA on MRI (P=0.002) and conversion to surgery (P=0.015) were found to be significantly associated with a poorer recovery at the observational final follow-up. Further, the presence of the pyramidal tract sign (P=0.043) was significantly associated with a poor recovery at the final follow-up after surgery.
Conclusion:
The presence of a high signal intensity change on T2-weighted MRI and the pyramidal tract sign can be used as prognostic factors for patients with CSA.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Brain WR, Northfield D, Wilkinson M . The neurological manifestations of cervical spondylosis. Brain 1952; 75: 187–225.
Keegan JJ . The cause of dissociated motor loss in the upper extremity with cervical spondylosis, a case report. J Neurosurg 1965; 23: 528–536.
Sobue I, Kato H, Yanagi T . Clinical characteristics of cervical spondylotic amyotrophy. Rinsho Seikeigeka 1975; 10: 999–1006.
Yanagi T, Kato H, Sobue T . Clinical characteristics of cervical spondylotic amyotrophy. Rinsho Seikeigaku 1976; 16: 520–528.
Gebere-Michael SG, Johnston JC, Metaferia GZ, Wuhib MZ, Fernandez HH . Bilaterally symmetric cervical spondylotic amyotrophy: a novel presentation and review of the literature. J Neurol Sci 2010; 290: 142–145.
Ito T, Tsuji H, Tamaki T, Miyasaka H, Toyota A . The clinical consideration of the dissociated motor loss syndrome (Keegan) in diseases of the cervical spine. Nippon Seikeigeka Gakkai Zasshi 1980; 54: 131–151.
Kameyama T, Ando T, yanagi T, Yasui K, Sobue G . Cervical spondylotic amyotrophy: magnetic resonance imaging demonstration of intrinsic cord pathology. Spine (Phila Pa 1976) 1988; 23: 448–452.
Kaneko K, Taguchi T, Toyama K, Kato Y, Azuma Y, Kawai S . Distal-type cervical spondylotic amyotrophy: assessment of pathophysiology from radiological findings on magnetic resonance imaging and epidurally recorded spinal cord responces. Spine 2004; 29: E185–E188.
Hattori S, Kawai S . Diagnosis of cervical spondylosis. Orthopaedic Mook 1979; 6: 13–40 (Jpn).
Jiang SD, Jiang LS, Dai LY . Cervical spondylotic amyotrophy. Eur Spine J 2011; 20: 351–357.
Inui Y, Miyamoto H, Sumi M, Uno K . Clinical outcomes and predictive factors relating to prognosis of conservative and surgical treatment for cervical spondylotic amyotrophy. Spine (Phila Pa 1976) 2011; 36: 794–799.
Chen CJ, Lyu RK, Lee ST, Wong YC, Wang LJ . Intramedullary high signal intensity on T2-weighted MR images in cervical spondylotic myelopathy: prediction of prognosis with type of intensity. Radiology 2001; 221: 789–794.
Wada E, Yonenobu K, Suzuki S, Kanazawa A, Ochi T . Can intramedullary signal change on magnetic resonance imaging predict surgical outcome in cervical spondylotic myelopathy? Spine (Phila Pa 1976) 1999; 24: 455–461 (discussion 462).
Yagi M, Ninomiya K, Kihara M, Horiuchi Y . Long-term surgical outcome and risk factors in patients with cervical myelopathy and a change in signal intensity of intramedullary spinal cord on magnetic resonance imaging. J Neurosurg Spine 2010; 12: 59–65.
Yukawa Y, Kato F, Yoshihara H, Yanase M, Ito K . MR T2 image classification in cervical compression myelopathy. Spine (Phila Pa 1976) 2007; 32: 1675–1678.
Tauchi R, Imagama S, Inoh H, Yukawa Y, Kanemura T, Sato K et al. Risk factors for a outcome following surgical treatment of cervical spondylotic amyotrophy: a multicenter study. Eur Spine J 2013; 22: 156–161.
Uchida K, Nakajima H, Yayama T, Sato R, Kobayashi S, Kokubo Y et al. Anterior and posterior decompressive surgery for progressive amyotrophy associated with cervical spondylosis: a retrospective study of 51 patients. J Neurosurg Spine 2009; 11: 330–337.
Uchida K, Nakajima H, Okazawa H, Kimura H, Kudo T, Watanabe S et al. Clinical significance of MRI/(18)F-PET fusion imaging of the spinal cord in patients with cervical compressive myelopathy. Eur J Med Mol Imaging 2012; 39: 1528–1537.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Additional information
Disclaimer
This article has not been published or submitted for publication elsewhere. No benefits in any form have been received or will be received from any commercial party related directly or indirectly to the subject of this article.
Rights and permissions
About this article
Cite this article
Iizuka, Y., Iizuka, H., Mieda, T. et al. Prognostic factors for cervical spondylotic amyotrophy: are signs of spinal cord involvement associated with the neurological prognosis?. Spinal Cord 52, 364–367 (2014). https://doi.org/10.1038/sc.2014.23
Received:
Revised:
Accepted:
Published:
Issue date:
DOI: https://doi.org/10.1038/sc.2014.23
Keywords
This article is cited by
-
Cervical spondylotic amyotrophy: a systematic review
European Spine Journal (2019)
