Clinical diagnosis and surgical treatment of cervical spondylosis with distal upper extremity amyotrophy
10.3760/cma.j.issn.0253-2352.2019.24.003
- VernacularTitle: 颈椎病伴上肢远端肌萎缩的临床诊断与手术治疗
- Author:
Hongli WANG
1
;
Feizhou LYU
;
Xiaosheng MA
;
Xinlei XIA
;
Jianyuan JIANG
Author Information
1. Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai 200040, China
- Publication Type:Clinical Trail
- Keywords:
Cervical vertebrae;
Spinal cord compression;
Muscular atrophy;
Spinal fusion
- From:
Chinese Journal of Orthopaedics
2019;39(24):1507-1513
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To summarize the clinical features of cervical spondylosis with distal upper extremity amyotrophy; and further analyze the clinical efficacy of cervical anterior decompression and fusion on cervical spondylosis with distal upper extremity amyotrophy.
Methods:Thirty cases of cervical spondylosis with distal upper extremity amyotrophy were analyzed retrospectively from June 2006 to June 2015. nineteen males and eleven females with an average age of 55.20±9.08 years (41 to 72 years) were included. The preoperative course was 1 to 108 months with a median of 6 months. The muscle extent of the affected group, the segmentation and location of spinal canal stenosis, and the results of neurophysiological examination were analyzed. The muscular strength recovery of atrophic muscles was evaluated by Manual Muscle Testing (MMT), and the clinical satisfaction was assessed at the last followed up.
Results:The muscles involved in patients of cervical spondylosis with distal upper extremity amyotrophy are mainly the thenar muscle (17 cases, 56.7%), interosseous muscle (15 cases, 50.0%), and shypothenar muscles (13 cases, 43.3%). Most cases of imaging findings showed multi-segmental degeneration, of which C5, 6 (24 cases, 80.0%), C6,7 (21 cases, 70.0%) segments were most common, and the types of anterior compression: 23 segments (33.5%) of the central type, 37 segments (54.4%) of the lateral-central type, and 8 segments (11.8%) of the foramen type. Neuroelectrophysiological examination showed that cervical spinal cord anterior horn cells or nerve root damage, the most commonly involved segments of C7, C8, T1(18 cases, 60.0%). The average follow-up time was 36.8 months. At the last follow-up, MMT assessment showed that thirteen patients (43.3%) in this group had muscle strength recovery for more than one grade at the last follow-up. The average clinical satisfaction was 73.4%.
Conclusion:The clinical diagnosis of cervical spondylosis with distal upper extremity amyotrophy requires a combination of clinical symptoms, imaging findings and neurophysiological examination results for comprehensive judgment. Cervical anterior decompression and fusion can effectively prevent the progression of cervical spondylosis in distal upper extremity amyotrophy patients, and some patients can get a good muscle recovery.
