Clinical Outcomes of Anterior Cervical Decompression and Fusion Therapy for Patients With Hirayama Disease

Hongju Liu; Zhe Zhang; Sining Li; Yuli Hou; Xuezhi Tong; Yanbing Yu; Hao Wu

doi:10.1016/j.wneu.2024.02.145

Clinical Outcomes of Anterior Cervical Decompression and Fusion Therapy for Patients With Hirayama Disease

World Neurosurg. 2024 Mar 5:S1878-8750(24)00357-7. doi: 10.1016/j.wneu.2024.02.145. Online ahead of print.

Authors

Hongju Liu¹, Zhe Zhang¹, Sining Li², Yuli Hou², Xuezhi Tong¹, Yanbing Yu¹, Hao Wu³

Affiliations

¹ Department of Neurosurgery, China-Japan Friendship Hospital, Beijing, China.
² Department of Anesthesiology, China-Japan Friendship Hospital, Beijing, China.
³ Department of Neurosurgery, China-Japan Friendship Hospital, Beijing, China; Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China. Electronic address: wuhaoneurosurgery@163.com.

PMID: 38447739
DOI: 10.1016/j.wneu.2024.02.145

Abstract

Objectives: To investigate the clinical outcomes of anterior cervical decompression and fusion (ACDF) surgery for the treatment of Hirayama disease (HD).

Methods: In this study, 15 patients with HD who underwent ACDF operation between March 2022 and March 2023 with complete data were retrospectively analyzed. Following the diagnosis, conservative treatment was ineffective, and thus, disease progression severely affected the quality of life (QOL) of patients. ACDF was performed in the China-Japan Friendship Hospital, and patients were regularly followed up postoperatively. The cervical range of motion (ROM), the anteroposterior and transverse diameter of the spinal cord, and their ratio was measured before and after the operation. The neurologic function of patients before and after the last follow-up was evaluated using the selected brief-Michigan Hand Questionnaire (sb-MHQ), whilst the overall therapeutic effect after the operation was evaluated using Odom's criteria.

Results: All patients were followed up for an average of 12 ± 4.5 (6-18) months. Dynamic X-ray displayed that the ROM of cervical vertebrae decreased from 72.73 ± 12.72° (53-97°) to 33.53° ± 10.34° (15-54°) (P < 0.001). Moreover, flexion cervical magnetic resonance imaging (MRI) performed after the operation revealed that spinal cord compression was markedly relieved, and the ratio of the anteroposterior diameter of the spinal cord to the transverse diameter increased from 0.27 ± 0.09 to 0.43 ± 0.03 (P < 0.001). At the last follow-up visit, finger extension tremor symptoms were alleviated, although they did not completely disappear. Contrastingly, muscle atrophy showed no significant improvement. Finally, the sb-MHQ score significantly increased from 17.33±1.76 preoperatively to 24.80±1.78 at the last follow-up (P<0.001).

Conclusions: Our results collectively highlighted the efficacy of ACDF for the treatment of HD. This procedure can limit excessive cervical flexion and repeated compression of the spinal cord during cervical movement and considerably improve upper limb functions.

Keywords: Anterior cervical decompression and fusion; Hirayama disease; Selected brief-Michigan Hand Questionnaire.