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2022, Vol. 26 ›› Issue (11): 1788-1792Cervical spondylotic amyotrophy: problems about classification, diagnosis, treatment, and prognosisLü Shuaiyao, Guan Haishan, Hao Chen, Ding Zhuangzhi
Abstract: BACKGROUND: Treatments for cervical spondylotic amyotrophy are still controversial. For cervical spondylotic amyotrophy patients, conservative treatment can generally stabilize or improve symptoms, but there is no cure. Surgical treatment is recommended for cervical spondylotic amyotrophy with progressive or severe neurological deterioration; however, most clinicians choose surgical methods based on their own clinical experience, and there is no unified standard or industry consensus. The prognosis of different types of cervical spondylotic amyotrophy is significantly different, which may influence the selection of surgical options. OBJECTIVE: To summarize and analyze the pathogenesis, diagnosis, clinical manifestations, types, treatments, and prognosis of cervical spondylotic amyotrophy by reviewing the related researches of cervical spondylotic amyotrophy, in order to provide reference for the selection of clinical treatment and surgical options. METHODS: Articles related to cervical spondylotic amyotrophy published from 1952 to 2020 were retrieved by computer in PubMed, EMbase, Web of Science, CNKI, and WanFang databases. Finally 44 articles that met the inclusion criteria were selected. RESULTS AND CONCLUSION: The clinical manifestations of cervical spondylotic amyotrophy are asymmetry, segmental and other characteristics of upper limb motor weakness accompanied by obvious muscle atrophy, while the lower limbs are not characterized by obvious sensory disturbance or spastic paralysis. Clinically, according to the position of muscle atrophy, it is classified into proximal type, distal type and mixed type. This disease needs to be distinguished from motor neuron disease and muscular dystrophy to avoid misdiagnosis and erroneous treatment. The pathogenesis of cervical spondylotic amyotrophy is yet unclear. There are two views on ventral nerve root and spinal anterior horn injury. The latter is recognized by most scholars. The diagnosis of cervical spondylotic amyotrophy is mainly based on clinical symptoms, imaging examinations, and neuroelectrophysiological examinations. Some diseases, such as motor neuron disease, should be excluded in differential diagnosis. Surgical treatment is mainly used for cervical spondylotic amyotrophy. Anterior cervical spine anterior surgery is the first choice, and posterior surgery is preferred for patients with multi-segment cervical posterior longitudinal ligament ossification, anterior decompression impossible or high risk of decompression. Different types of cervical spondylotic amyotrophy patients have different prognostic results after surgery. Prognosis of the proximal type is better than that of the distal type, and prognosis of the mixed type is the worst. Surgery via the anterior cervical approach has better results than that via the posterior cervical approach. Key words:cervical spondylotic amyotrophy, muscular atrophy, upper limbs, nerve root, spinal anterior horn cells, motor neuron disease, mechanism, prognosis |