Efficacy of anterior cervical decompression and fusion procedures for monomelic amyotrophy treatment: a prospective randomized controlled trial: clinical article.
OBJECTIVE
Monomelic amyotrophy (MMA) is a benign, self-limiting lower motor neuron disease. Optimal surgical strategies-discectomy decompression and fusion (DDF) or corpectomy decompression and fusion (CDF)-for patients with aggravated symptoms (within 6 months of presentation) are controversial, particularly in those who are ineligible for conventional treatment. These 2 methods of anterior cervical decompression and fusion for MMA in patients unwilling or unable to wear a conventional cervical collar long term were evaluated.


METHODS
Anterior cervical decompression and fusion were performed in 48 male patients with MMA between September 2007 and September 2010. Patients were randomly treated with anterior cervical discectomy decompression with autologous iliac crest bone grafting and internal plate fixation (DDF group: 24 patients) or anterior cervical corpectomy, posterior longitudinal ligament resection, autologous iliac crest bone grafting, and internal plate fixation (CDF group: 24 patients). Subjective symptom assessments and electromyography (EMG) examinations were conducted both preoperatively and postoperatively.


RESULTS
Subjective assessments and EMG studies (mean follow-up duration 25.9 months) indicated improvement in 64.6% and 60% of patients, respectively. No significant correlations between the effectiveness of surgery and age at symptom onset, preoperative symptom duration, or postoperative follow-up time were found.


CONCLUSIONS
The lack of a significant difference in effectiveness between DDF and CDF favors DDF as more clinically applicable because of its lower procedural risks. As a second-line alternative to cervical collar treatment, surgical anterior cervical decompression and fusion via DDF or CDF may prevent further deterioration and produce good short-term therapeutic effects in patients with MMA; however, cervical collar treatment is recommended for eligible patients because of its lower associated risks.
Department of Orthopaedics, Huashan Hospital, and Spine Center, Fudan University, Shanghai, People's Republic of China.
Feizhou
F
Lu
Hongli
H
Wang
Jianyuan
J
Jiang
Wenjun
W
Chen
Xin
X
Ma
Xiaosheng
X
Ma
Xinlei
X
Xia
Lixun
L
Wang
D000293:Adolescent; D016025:Bone Transplantation; D002574:Cervical Vertebrae / Q000473:pathology / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods*; D017586:Diskectomy / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D007085:Ilium / Q000637:transplantation; D008279:Magnetic Resonance Imaging; D008297:Male; D013123:Spinal Fusion / Q000379:methods*; D014897:Spinal Muscular Atrophies of Childhood / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult