Cervical amyotrophy caused by hypertrophy of the posterior longitudinal ligament

Mizuno, Junichi; Nakagawa, Hiroshi; Hashizume, Yoshio

doi:10.1038/sj.sc.3101321

Cited by 8 publications

(7 citation statements)

References 17 publications

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“…Some authors have included patients with posterior column involvement in the lower limbs and/or severe gait disturbance. 9,12 Our patients were more homogenous in their presentation; none had gait impairment or sensory deficits in the lower limbs. Our patients therefore fit the definition of CSA proposed by Ebara and colleagues.…”

Section: Clinical Features Of Csamentioning

confidence: 65%

Distal-type cervical spondylotic amyotrophy: incidence and outcome after central corpectomy

Rao¹,

Rajshekhar²

2009

SPI

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Object Distal-type cervical spondylotic amyotrophy (CSA) is a rare form of cervical spondylotic myelopathy (CSM). The authors documented the incidence, clinical presentation, radiological features, and outcome following central corpectomy (CC) in patients with this entity. Methods The authors performed a retrospective institutional database search of patients who underwent decompressive surgery for CSM between 1992 and 2006 to identify patients with distal-type CSA. Distal-type CSA was defined as weakness and wasting of hands and forearms without gait impairment (Nurick Grades 0 and 1) nor any sensory symptoms or signs in the lower limbs. Results The authors identified 7 male patients (1.1%) with distal-type CSA from among 653 patients who underwent either cervical laminectomy (135 patients) or CC (518 patients). There were sensory symptoms or signs in the upper limbs in all but 1 of the patients. Increased signal intensity in the cord was demonstrated on T2-weighted MR images in all patients. The compression was mainly at the C-6 vertebral level. At a mean follow-up of 46.5 months (range 12–98 months), 6 patients had improved by a mean patient perceived outcome score of 66.7% (range 20–100%). Patients' modified Japanese Orthopedic Association scores improved from a preoperative mean (± SD) of 16.1 ± 0.7, to a follow-up mean of 17.4 ± 0.5 (p = 0.004, paired t-test). One patient whose condition worsened 7 months after CC received a diagnosis of a coexistent motor neuron disease. Conclusions Distal-type CSA is a rare form of CSM that should be differentiated from motor neuron disease on the basis of subtle sensory symptoms or signs in the upper limbs, and the presence of significant cord compression on the MR imaging. Patient outcome after central corpectomy is good and long lasting.

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Section: Clinical Features Of Csamentioning

confidence: 65%

Distal-type cervical spondylotic amyotrophy: incidence and outcome after central corpectomy

Rao¹,

Rajshekhar²

2009

SPI

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“…Crandall and Batzdorf 6 have indicated that somewhat less than 7% of patients with cervical spondylotic myelopathy present with minimal sensation loss, and this presentation was classified as a "motor system type of myelopathy." Others 7,8,12,14 have suggested that such patients sustain anterior horn dysfunction or selective injury of the anterior radices of the nerve root. Electromyography studies in patients with anterior radices or nerve root injury have shown fibrillation and positive sharp waves but no fasciculation or synchronization.…”

Section: Discussionmentioning

confidence: 99%

“…6,7 In contrast to the typical features of spastic paraly-sis caused by cervical spondylosis or an ossified posterior longitudinal ligament, the signs and symptoms of progressive muscle weakness in the arm(s) may show an insidious onset without any preceding symptoms or sen-Anterior and posterior decompressive surgery for progressive amyotrophy associated with cervical spondylosis: a retrospective study of 51 patients Clinical article sory disturbances. 13,14 Based on these features, the condition is sometimes called "cervical spondylotic amyotrophy" 7,8,14 or "dissociated motor loss." 12 Note, however, that the basic pathology is compression of the spinal cord segment, 6,12 which primarily affects the motoneurons and/ or descending pyramidal tract, or the nerve root(s).…”

mentioning

confidence: 99%

Anterior and posterior decompressive surgery for progressive amyotrophy associated with cervical spondylosis: a retrospective study of 51 patients

Uchida

Nakajima

Yayama

et al. 2009

SPI

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Object The aims of this study were to review the clinicoradiological findings in patients who underwent decompressive surgery for proximal and distal types of muscle atrophy caused by cervical spondylosis and to discuss the outcome and techniques of surgical intervention. Methods Fifty-one patients (43 men and 8 women) with proximal (37, with arm drop) and distal muscle atrophy (14, with wrist drop) underwent cervical decompression (39 anterior decompressions and 12 open-door C3–7 laminoplasties with microsurgical foraminotomy) for muscle weakness in the upper extremities. The clinical course, type of spinal cord compression, abnormal signal intensity on high-resolution MR imaging, and postdecompression improvement in muscle power were reviewed at a mean follow-up of 2.6 years (range 0.8–9.4 years). Results The most commonly affected vertebrae were C4–5 and C5–6, and C5–6 and C6–7 in patients with proximal or distal muscle atrophy, respectively; the respective numbers of affected vertebrae were 1.5 and 2.2. Transaxial MR imaging showed medial compression of the spinal cord in 20 patients (in 12 with proximal and 8 with distal muscle atrophy), paramedial compression in 22 (17 and 5 patients, respectively), and foraminal compression in 9 (8 and 1 patient, respectively). Increased signal intensity on MR imaging was observed in 85.0, 22.7, and 11.1% of cases of medial, paramedial, and foraminal compression, respectively. Increased signal intensity at the affected muscle segment level was observed in 52.9, 40.0, and 0% of cases, respectively. Sixty-two percent of patients with proximal muscle atrophy gained 1 or more grades of muscle power on manual muscle testing (MMT), whereas 64.3% with distal muscle atrophy failed to gain even 1 grade of improvement. The recovery of muscle power correlated with disease duration and the percent voltage of Erb point or wrist-stimulated muscle evoked potentials but not with preoperative MMT, longitudinal range of spinal cord compression, signal change on T2-weighted MR imaging, or surgical procedure. Conclusions Surgical outcome in patients with distal muscle atrophy was inferior to that in patients with proximal atrophy. The distal type was characterized by a long preoperative period, a greater number of cervical spine misalignments, a narrow spinal canal, and increased signal intensity on T2-weighted MR imaging. It is essential to perform a careful neurological evaluation, including sensory examination of the lower limbs, as well as neuroradiological and neurophysiological assessments to avoid confusion with motor neuron disease and to detect the coexistence of amyotrophic lateral sclerosis, especially when surgical treatment of cervical spondylosis is planned. The results of careful physical examination, MR imaging studies, and electromyography studies should be comprehensively evaluated to ascertain the pathophysiology of the muscle atrophy. It is very important to distinguish the pathophysiology caused by nerve root impingements from anterior horn dysfunction when making decisions about treatment strategy. Surgical treatment—with or without foraminotomy—for amyotrophy in cervical spondylosis requires urgent action with regard to human neuroanatomy and neural innervation of the paralyzed muscles.

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“…There is, however, a striking paucity of literature describing bilateral disease. A multiple database (PubMed, Scopus, Cochrane Database, Google Scholar) English language search of proximal CSA yields 72 cases, [2,5,[8][9][10][11][12]14,15] excluding patients with concomitant myelopathy or sensory impairment, [16][17][18] post-operative dissociated motor loss, [19] antecedent post-polio syndrome, [20] or associated Hirayama's disease [21]. These cases include two reports covering a total of three patients with bilateral signs, all readily distinguished from our case [2,9].…”

Section: Discussionmentioning

confidence: 99%

Bilaterally symmetric cervical spondylotic amyotrophy: A novel presentation and review of the literature

Geberemichael

Johnston

Metaferia

et al. 2010

Journal of the Neurological Sciences

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Cervical amyotrophy caused by hypertrophy of the posterior longitudinal ligament

Cited by 8 publications

References 17 publications

Distal-type cervical spondylotic amyotrophy: incidence and outcome after central corpectomy

Distal-type cervical spondylotic amyotrophy: incidence and outcome after central corpectomy

Anterior and posterior decompressive surgery for progressive amyotrophy associated with cervical spondylosis: a retrospective study of 51 patients

Bilaterally symmetric cervical spondylotic amyotrophy: A novel presentation and review of the literature

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