title: Characteristics and surgical results of the distal type of cervical spondylotic amyotrophy.
abstract: OBJECTIVE
  Cervical spondylosis that causes upper-extremity muscle atrophy without gait disturbance is called cervical spondylotic amyotrophy (CSA). The distal type of CSA is characterized by weakness of the hand muscles. In this retrospective analysis, the authors describe the clinical features of the distal type of CSA and evaluate the results of surgical treatment.
  
  
  METHODS
  The authors performed a retrospective review of 17 consecutive cases involving 16 men and 1 woman (mean age 56.3 years) who underwent surgical treatment for the distal type of CSA. The condition was diagnosed on the basis of cervical spondylosis in the presence of muscle impairment of the upper extremity (intrinsic muscle and/or finger extension muscles) without gait disturbance, and the presence of a compressive lesion involving the anterior horn of the spinal cord, the nerve root at the foramen, or both sites as seen on axial and sagittal views of MRI or CT myelography. The authors assessed spinal cord or nerve root impingement by MRI or CT myelography and evaluated surgical outcomes.
  
  
  RESULTS
  The preoperative duration of symptoms averaged 11.8 months. There were 14 patients with impingement of the anterior horn of the spinal cord and 3 patients with both anterior horn and nerve root impingement. Twelve patients were treated with laminoplasty (plus foraminotomy in 1 case), 3 patients were treated with anterior cervical discectomy and fusion, and 2 patients were treated with posterior spinal fixation. The mean manual muscle testing grade was 2.4 (range 1-4) preoperatively and 3.4 (range 1-5) postoperatively. The surgical results were excellent in 7 patients, good in 2, and fair in 8.
  
  
  CONCLUSIONS
  Most of the patients in this series of cases of the distal type of CSA suffered from impingement of the anterior horn of the spinal cord, and surgical outcome was fair in about half of the cases.
authors.affiliation: Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya;
authors.forename: Ryoji
authors.initials: R
authors.lastname: Tauchi
authors.forename: Shiro
authors.initials: S
authors.lastname: Imagama
authors.forename: Hidefumi
authors.initials: H
authors.lastname: Inoh
authors.forename: Yasutsugu
authors.initials: Y
authors.lastname: Yukawa
authors.forename: Tokumi
authors.initials: T
authors.lastname: Kanemura
authors.forename: Koji
authors.initials: K
authors.lastname: Sato
authors.forename: Yoshihito
authors.initials: Y
authors.lastname: Sakai
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Kamiya
authors.forename: Hisatake
authors.initials: H
authors.lastname: Yoshihara
authors.forename: Zenya
authors.initials: Z
authors.lastname: Ito
authors.forename: Kei
authors.initials: K
authors.lastname: Ando
authors.forename: Akio
authors.initials: A
authors.lastname: Muramoto
authors.forename: Hiroki
authors.initials: H
authors.lastname: Matsui
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Matsumoto
authors.forename: Junichi
authors.initials: J
authors.lastname: Ukai
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Kobayashi
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Shinjo
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Nakashima
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Morozumi
authors.forename: Naoki
authors.initials: N
authors.lastname: Ishiguro
mesh_terms: D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000601:surgery*; D003952:Diagnostic Imaging; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018908:Muscle Weakness / Q000209:etiology; D009134:Muscular Atrophy, Spinal / Q000209:etiology / Q000601:surgery*; D020127:Recovery of Function; D012189:Retrospective Studies; D055009:Spondylosis / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome; D034941:Upper Extremity
keywords: ACDF = anterior cervical discectomy and fusion; ALS = amyotrophic lateral sclerosis; CSA = cervical spondylotic amyotrophy; MMT = manual muscle testing; MP = metacarpophalangeal; atrophy; cervical spondylotic amyotrophy; distal type; hand weakness; surgical result