PDF(Pubmed)
Abstract：
OBJECTIVE: This is a retrospective analysis of prospectively collected single-center observational data. The aim is to evaluate atrophy and fatty degeneration rates of cervical spinal muscles in proximal cervical spondylotic amyotrophy (PCSA).
BACKGROUND: Proximal cervical spondylotic amyotrophy affects muscles in the upper extremities. In cases that lack improvement with conservative treatment, surgery is recommended. However, preoperative factors associated with poor outcomes remain unclear. We hypothesized that assessing fatty degeneration of the cervical spinal muscles and examining its relationship with functional impairment would help predict postoperative improvement in neurological function.
METHODS: This study included 18 patients who underwent PCSA surgery. We performed selective laminoplasty and foraminotomy. Preoperative paraspinal muscle cross-sectional area and fatty degeneration were quantified and correlated with neurological function.
RESULTS: Neurological improvement based on manual muscle testing was observed in 12/18 patients, comparing preoperative, perioperative, and over 12-month postoperative statuses. On the affected side, at the C4/5 level, fatty degeneration was more significant in the trapezius, whereas at the C5/6 level, fatty degeneration was more significant in the splenius capitis and trapezius. The fatty degeneration of the C4/5 and C5/6 trapezius was significantly correlated with preoperative muscle strength and postoperative muscle strength improvement.
CONCLUSIONS: The degree of fat infiltration of the muscle correlated with pre- and postoperative muscle strength at the lesion level. Thus, our results suggest a relationship between cervical muscle morphology and the clinical manifestations of PCSA. The marked increase in trapezius fatty infiltration at the C4/5 and C5/6 levels may be a valuable indicator to predict poor improvements in postoperative muscle strength.
BACKGROUND: Proximal cervical spondylotic amyotrophy affects muscles in the upper extremities. In cases that lack improvement with conservative treatment, surgery is recommended. However, preoperative factors associated with poor outcomes remain unclear. We hypothesized that assessing fatty degeneration of the cervical spinal muscles and examining its relationship with functional impairment would help predict postoperative improvement in neurological function.
METHODS: This study included 18 patients who underwent PCSA surgery. We performed selective laminoplasty and foraminotomy. Preoperative paraspinal muscle cross-sectional area and fatty degeneration were quantified and correlated with neurological function.
RESULTS: Neurological improvement based on manual muscle testing was observed in 12/18 patients, comparing preoperative, perioperative, and over 12-month postoperative statuses. On the affected side, at the C4/5 level, fatty degeneration was more significant in the trapezius, whereas at the C5/6 level, fatty degeneration was more significant in the splenius capitis and trapezius. The fatty degeneration of the C4/5 and C5/6 trapezius was significantly correlated with preoperative muscle strength and postoperative muscle strength improvement.
CONCLUSIONS: The degree of fat infiltration of the muscle correlated with pre- and postoperative muscle strength at the lesion level. Thus, our results suggest a relationship between cervical muscle morphology and the clinical manifestations of PCSA. The marked increase in trapezius fatty infiltration at the C4/5 and C5/6 levels may be a valuable indicator to predict poor improvements in postoperative muscle strength.
摘要：
目的：这是对前瞻性收集的单中心观察数据的回顾性分析。目的是评估近端颈椎病性肌萎缩症（PCSA）的颈脊髓肌的萎缩和脂肪变性率。
背景：近端颈椎病性肌萎缩影响上肢肌肉。在保守治疗缺乏改善的情况下，建议手术。然而,与不良结局相关的术前因素尚不清楚.我们假设评估颈椎肌肉的脂肪变性并检查其与功能损害的关系将有助于预测术后神经功能的改善。
方法：本研究包括18例接受PCSA手术的患者。我们进行了选择性椎板成形术和椎间孔切开术。术前对椎旁肌横截面积和脂肪变性进行量化，并与神经功能相关。
结果：在12/18患者中观察到基于手动肌肉测试的神经系统改善，术前比较，围手术期,和超过12个月的术后状态。在受影响的一方，在C4/5级别，脂肪变性在斜方肌中更为明显，而在C5/6级别，脂肪变性在脾炎和斜方肌中更为明显。C4/5和C5/6斜方肌脂肪变性与术前肌力和术后肌力改善显著相关。
结论：肌肉的脂肪浸润程度与病变水平的术前和术后肌力相关。因此，我们的结果表明宫颈肌肉形态与PCSA的临床表现之间存在关系。C4/5和C5/6水平的斜方肌脂肪浸润的显着增加可能是预测术后肌肉力量改善不良的有价值的指标。
背景：近端颈椎病性肌萎缩影响上肢肌肉。在保守治疗缺乏改善的情况下，建议手术。然而,与不良结局相关的术前因素尚不清楚.我们假设评估颈椎肌肉的脂肪变性并检查其与功能损害的关系将有助于预测术后神经功能的改善。
方法：本研究包括18例接受PCSA手术的患者。我们进行了选择性椎板成形术和椎间孔切开术。术前对椎旁肌横截面积和脂肪变性进行量化，并与神经功能相关。
结果：在12/18患者中观察到基于手动肌肉测试的神经系统改善，术前比较，围手术期,和超过12个月的术后状态。在受影响的一方，在C4/5级别，脂肪变性在斜方肌中更为明显，而在C5/6级别，脂肪变性在脾炎和斜方肌中更为明显。C4/5和C5/6斜方肌脂肪变性与术前肌力和术后肌力改善显著相关。
结论：肌肉的脂肪浸润程度与病变水平的术前和术后肌力相关。因此，我们的结果表明宫颈肌肉形态与PCSA的临床表现之间存在关系。C4/5和C5/6水平的斜方肌脂肪浸润的显着增加可能是预测术后肌肉力量改善不良的有价值的指标。
