• Fei Zou, Shuo Yang, Feizhou Lu, Xiaosheng Ma, Xinlei Xia, and Jianyuan Jiang.
• Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai, China.
• World Neurosurg. 2019 Feb 1; 122: e296-e301.

ObjectiveWe explored the factors affecting the surgical outcomes of Hirayama disease (HD).MethodsWe enrolled 40 patients with a diagnosis of HD in the present study. Cervical spine magnetic resonance imaging (MRI) was performed before surgery with the neck in the cervical neutral and flexion positions. Fusion surgery was performed at the most severely compressed 2 levels according to the flexion sagittal MRI findings. The patients were divided into improvement and no-improvement groups according to Odom's scale 6 months after surgery. The axial MRI parameters in the neutral and flexion positions at the most severely compressed segment were measured. P values < 0.05 were considered statistically significant.ResultsThe average age was 18.4 ± 2.27 years, and the average disease duration was 1.8 ± 1.2 years. The main symptomatic side of HD statistically matched the atrophied side of the spinal cord (P < 0.001). Based on the pathophysiology of spinal cord flattening with flexion, the parameters indicating atrophy of the spinal cord and the ability of the spinal cord to recover from flattening were significantly larger in the improvement group (P < 0.05). Receiver operating characteristic curves showed good prognostic capacity for these parameters (P < 0.05).ConclusionsThe main side of the symptoms in patients with HD corresponded with ipsilateral spinal cord atrophy found on MRI. Also, atrophy of the spinal cord in the neutral position MRI study and the ability of the spinal cord to recover were significantly related to the surgical outcome. These factors might be used as potential indications for surgery of HD.Copyright © 2018 Elsevier Inc. All rights reserved.

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