• Ryoji Tauchi, Shiro Imagama, Hidefumi Inoh, Yasutsugu Yukawa, Tokumi Kanemura, Koji Sato, Yuji Matsubara, Atsushi Harada, Yudo Hachiya, Mistuhiro Kamiya, Hisatake Yoshihara, Zenya Ito, Kei Ando, and Naoki Ishiguro.
• Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya 4668550, Japan.
• Eur Spine J. 2013 Jan 1;22(1):156-61.

IntroductionCervical spondylotic amyotrophy (CSA) is characterized by muscle atrophy in the upper extremities without gait disturbance. However, the indications and outcomes of surgical treatment for CSA have not been clarified. The purpose of this study was to determine the risk factors for a poor outcome following surgical treatment of CSA.Materials And MethodsWe performed a retrospective review of CSA in patients from 1991 to 2010 through a multicenter study. We collected information regarding age, type of muscle atrophy, preoperative manual muscle test (MMT), duration of symptoms, high-intensity areas on T2-weighted MR images, low-intensity areas on T1-weighted MR images, levels of spinal canal stenosis, cervical kyphosis and surgical procedures (laminoplasty, anterior cervical discectomy and fusion and posterior spinal fusion), and calculated overall risk factors related to a poor outcome following surgery. Univariate analyses and multivariate logistic regression analysis were performed to identify correlates of a poor outcome.ResultsFifty-nine patients, 95 % male (56 patients), were included in our analysis with a mean age of 59 years (range 32-78 years). Eighteen patients did not improve after surgery. Symptom duration (OR = 1.263), preoperative MMT grade (OR = 0.169) and distal type of CSA (OR = 9.223) were all associated with an increased risk of a poor surgical outcome.ConclusionEarly surgery is recommended for CSA patients in whom conservative treatment has not been successful. We also recommend surgery for patients who have severe preoperative muscle weakness or have the distal type of CSA.

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