Monomelic Amyotrophy/Hirayama Disease: Surgical Outcome in a Large Cohort of Indian Patients.

Autor: Vengalil S; Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India., Pruthi N; Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India., Bhat D; Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India., Uppar AM; Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India., Polavarapu K; Children's Hospital of Eastern Ontario Research Institute, University of Ottawa and Division of Neurology, Department of Medicine, The Ottawa Hospital, Ottawa, Canada., Preethish-Kumar V; Morriston Hospital, Swansea Bay University Health Board, Swansea, UK., Nashi S; Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India., Rajesh S; Department of Neurorehabilitation, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India., Aswini NS; Department of Neurorehabilitation, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India., Behera BP; Department of Neurorehabilitation, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India., Vandhiyadevan GD; Department of Neurorehabilitation, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India., Prasad C; Department of Neuro Imaging and Interventional neurology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India., Baskar D; Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India., Kulanthaivelu K; Department of Neuro Imaging and Interventional neurology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India., Saravanan A; Department of Neuro Imaging and Interventional neurology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India., Kandavel T; Department of Biostatistics, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India., Nishadham V; Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India., Huddar A; Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India., Unnikrishnan G; Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India., Thomas A; Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India., Keerthipriya MS; Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India., Sanka SB; Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India., Manjunath N; Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India., Valasani RK; Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India., Bardhan M; National Institute of Cholera and Enteric Diseases, Kolkata, Indian Council of Medical Research, New Delhi, India., Nalini A; Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India. Electronic address: atchayaramnalini@yahoo.co.in.
Jazyk: angličtina
Zdroj: World neurosurgery [World Neurosurg] 2024 Mar; Vol. 183, pp. e88-e97. Date of Electronic Publication: 2023 Nov 23.
DOI: 10.1016/j.wneu.2023.11.087
Abstrakt: Background: Hirayama disease (HD) is a cervical compressive myelopathy. Anterior cervical discectomy and fusion (ACDF) is identified as the best surgical approach. We evaluated surgical outcomes and factors influencing ACDF in HD.
Methods: Between 2015 and 2019, 126 patients with HD underwent ACDF. Contrast magnetic resonance imaging of the cervical spine in full flexion was performed. Clinical examination and preoperative/postoperative assessment of hand function using Fugl-Meyer assessment, Jebsen-Taylor hand function test, and handheld dynamometry were performed at 3-monthly intervals for 1 year. Surgical outcomes were assessed as per the Odom criteria and Hirayama outcome questionnaire.
Results: Age at onset and duration of illness were 12-31 years (mean, 18 ± 2.7) and 1-96 months (32.7 ± 24.4), respectively. All patients had progressive weakness and wasting of the affected limb. Cord atrophy was seen in 97.1%, with epidural detachment and engorgement of the posterior epidural venous plexus in all. All patients underwent ACDF. Of these patients, 54% had an excellent/good outcome and 39% had a satisfactory outcome as per the Odom scale at last follow-up (mean, 44.9 ± 16.5 months) after surgery. Handheld dynamometry showed improvement from preoperative values to 1 year follow-up. Duration of illness and age at onset had a negative correlation and the preoperative Fugl-Meyer score had a positive correlation with improvement.
Conclusions: ACDF resulted in remarkable improvement or stabilization in neurologic deficits in many patients with HD. Because motor disability ensues over time, early surgical intervention during the progressive phase is advocated.
(Copyright © 2023 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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