Midterm clinical outcomes and radiological results of surgical treatment for Hirayama disease / 北京大学学报(医学版)

ABSTRACT

Objective:To assess the midterm clinical and radiological outcomes of internal fixation and fusion for the treatment of Hirayama disease and to evaluate the clinical significance and value of this procedure.Methods:In the study,36 patients were treated with anterior cervical internal fixation and fusion.The clinical outcomes including muscle strength and atrophy were recorded.The radiological outcomes including range of motion of cervical spine and the cross-sectional area of spinal cord at each level on MRI scan were measured before and at 3 month,1 year and 2 years follow-up time points after surgery.Results:(1) Clinical outcomes:all the patients showed no further progression of symptoms except one patient with mild progression of muscular weakness and atrophy.As the time passed by,the ratio of the patients with muscle strength and atrophy improvement increased.There were 26.5 ％ of patients in 3 months,36.0％ in 1 year and 85.7％ in 2 years who experienced muscle strength improvement.8.8％ of patients in 3 months,24.0％ in 1 year and 35.8％ in 2 years felt muscle atrophy improvement.And 12 of the 14 patients showed improved muscle strength and atrophy at the end of 2 years period follow-up.(2) Radiological outcomes:the range of motion (ROM) of C2-C7 was significantly decreased after the operation.The ROM of preoperation was 62.25° ±2.10° and that of 2 years postoperation was 13.67° ± 7.51°(P ＜ 0.01).The spinal cord was of no compression on flexion MRI.The cross-section area of spinal cord on MRI was significantly increased only at C6 level (P ＜0.05) at the end of three months follow-up.The level of increased cross-section area rose to C4-C5-C6 levels (P ＜0.01) in 1 year and to C4-C5-C6-C7 levels at the end of 2 years follow-up P ＜ 0.05).The cross-section area increased 15.60％ at C4,19.08％ at C5,21.60％ at C6 and 23.91％ at C7 with significant difference (P ＜0.05) 2 years after the operation.Conclusion:Anterior cervical internal fixation and fusion is an effective surgical treatment for Hirayama disease and may provide preferable midterm clinical and radiological outcomes.This procedure has clinical significance and value in terms of control of the progression and outcome of this disease.