• Tsuyoshi Yamada, Toshitaka Yoshii, Shuta Ushio, Takashi Taniyama, Takashi Hirai, Hiroyuki Inose, Kenichiro Sakai, Shigeo Shindo, Yoshiyasu Arai, and Atsushi Okawa.
• Department of Orthopaedic Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchi-city, Saitama, 332-8558, Japan.
• Eur Spine J. 2019 Oct 1; 28 (10): 2333-2341.

PurposeDistal-type cervical spondylotic amyotrophy (CSA) is a rare form of cervical spondylosis that causes muscle weakness of upper extremities. The pathophysiology and appropriate surgical method for the treatment of CSA are still controversial. We investigated clinical outcomes in surgically treated distal-type CSA.MethodsThe authors executed an analysis of the outcomes of 43 consecutive spinal surgeries performed in distal-type CSA patients. The duration of symptoms, perioperative manual muscle test (MMT) results, radiological findings, and perioperative complications were reviewed. We compared surgical outcomes between different approaches and examined the factors related to poor outcomes (MMT improvement ≤ 0) after surgery.ResultsThe pathophysiology of CSA was mostly caused by a combination of multiple lesions in the anterior horn and/or nerve root. Nineteen of 29 patients (65.5%) who received anterior approach methods were included in the good outcome group (MMT improvement ≥ 1), whereas 7 of 14 patients (50.0%) in the posterior group were classified as good. In the anterior group, the mean MMT grade significantly improved from 2.6 to 3.4 (p = 0.0035) despite the higher rate of complications. The duration of symptoms was substantially associated with poor outcomes. The MMT grade significantly improved from 2.2 to 3.2 (p = 0.0118) in the < 6 months group. Cervical alignments and preoperative MMT grade were not statistically associated with poor outcomes.ConclusionsPatients with poor outcomes had symptoms for a longer duration. We found tolerable clinical outcomes within 6 months from onset. The anterior approaches might be recommended because this procedure significantly improved MMT levels in the hands. These slides can be retrieved under Electronic Supplementary Material.

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