title: Minimum invasive posterior decompression for cervical spondylotic amyotrophy.
abstract: BACKGROUND
  Cervical spondylotic amyotrophy (CSA), characterized by amyotrophy and muscular weakness of the upper limbs, is caused by damage to anterior spinal root or anterior horn of the spinal cord. Formerly, anterior decompression and fusion were performed for treatment of CSA, but it has recently been reported that posterior decompression is also effective. However, a consensus on the choice of procedure has not yet been reached. Selective laminoplasty as minimally invasive surgery is a posterior decompression procedure that alleviates axial neck pain. Because, for CSA patients, the responsible lesion level is localized, this procedure combined with foraminotomy enables simultaneous spinal cord and root decompression. Therefore, we report the results of this treatment for CSA.
  
  
  METHODS
  Subjects were 28 patients (25 males, 3 females), average age 50.6 years and average follow-up 43.5 months. The muscles involved were deltoid for 14 patients, biceps for 11, and extensor digitorum communis and/or intrinsic muscles of the hand for 9. MMT scores were grade 2 for 23 cases and grade 3 for 5 cases. To evaluate the results of minimally invasive surgery, cervical ROM (C2-7) and postoperative neck pain (VAS) on the first postoperative day and 1 week after surgery were evaluated.
  
  
  RESULTS
  Muscle strength improvement was rated as "excellent" for 18 patients, "good" for 9, and "fair" for 1, with none rated "poor". Four of 10 patients whose muscle strength did not fully improve had distal type CSA and/or had preoperative MMT scores of 2. Average %ROM was 91.2 % and almost complete cervical ROM was maintained. The average postoperative VAS score was 2.6 on the first postoperative day and 1.2 1 week after surgery.
  
  
  CONCLUSIONS
  Selective laminoplasty with segmental decompression is advantageous for minimizing postoperative neck pain and for simultaneous decompression of the affected spinal cord segment and nerve root.
authors.affiliation: Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo 064-8543, Japan. takebaya@sapmed.ac.jp
authors.forename: Tsuneo
authors.initials: T
authors.lastname: Takebayashi
authors.forename: Mitsunori
authors.initials: M
authors.lastname: Yoshimoto
authors.forename: Kazunori
authors.initials: K
authors.lastname: Ida
authors.forename: Hajime
authors.initials: H
authors.lastname: Tsuda
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Terashima
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Yamashita
mesh_terms: D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D006801:Humans; D007796:Laminectomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D018908:Muscle Weakness / Q000209:etiology / Q000601:surgery*; D009133:Muscular Atrophy / Q000209:etiology / Q000601:surgery*; D016059:Range of Motion, Articular; D013119:Spinal Cord Injuries / Q000150:complications*; D055009:Spondylosis / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome