Clinical outcomes and predictive factors relating to prognosis of conservative and surgical treatments for cervical spondylotic amyotrophy.

摘要

STUDY DESIGN: Retrospective clinical analyses of patients with cervical spondylotic amyotrophy (CSA). OBJECTIVE: To report the clinical outcomes and predictive factors relating to the prognosis in conservative and surgical treatments for CSA. SUMMARY OF BACKGROUND DATA: CSA is a clinical entity characterized by muscle atrophy in the upper extremity without marked sensory disturbance or spastic tetraparesis. The indications for, and outcomes of conservative and surgical treatments for CSA have not been clearly enunciated. METHODS: Ninety patients with CSA were enrolled in this study. All of them initially received continuous cervical traction for 2 to 3 weeks as inpatients. If this conservative treatment was ineffective, surgical intervention was carried out after informed consent was obtained. We investigated the outcome of conservative treatment, the predictive factors relating to the prognosis of the conservative treatment, and the outcome of surgery after initial conservative treatment failed. RESULTS: After initial conservative treatment, 42 patients (46.7%) showed excellent or good outcome, 29 patients underwent surgery, and 19 patients declined surgery. Consequently, 61 patients were conservatively followed up. At final follow-up, 40% of the patients still showed excellent or good neurologic status by conservative treatment, and this group was characterized by age <50 years, duration of symptoms <6 months, single-level stenosis, foraminal stenosis, and a good response to traction therapy. Additional 5 patients underwent surgery during follow-up because of deterioration of symptom, and 34 patients consequently underwent surgery at the final follow-up. Of 34, 28 (82%) patients who underwent surgery obtained neurologic improvement. CONCLUSION: The present study has demonstrated the outcome of conservative and of surgical treatments for CSA, together with the predictive factors relating to the prognosis. Conservative treatment should be initially tried on CSA patients, especially those with predictive factors relating to a better prognosis. However, if conservative treatment failed, surgical intervention was successful.