Cervical spondylotic amyotrophy: a systematic review

Area of Science:

• Neurology
• Spinal Cord Disorders
• Musculoskeletal Diseases

Background:

• Cervical spondylotic amyotrophy (CSA) is a neurological condition affecting upper limb muscles.
• It is characterized by muscle weakness and atrophy, specifically without sensory deficits.
• The underlying pathophysiology involves selective injury to the ventral nerve root or anterior horn of the spinal cord.

Purpose of the Study:

• To provide a comprehensive overview of Cervical Spondylotic Amyotrophy (CSA).
• To delineate the history, epidemiology, etiology, and pathophysiology of CSA.
• To describe the classification, clinical features, diagnostic methods, differential diagnoses, natural history, and treatment of CSA.

Main Methods:

• A systematic literature search was performed across major databases (PubMed, EMBASE, Cochrane, Web of Science).
• The search covered literature from database inception up to April 3, 2018.
• The review synthesized information on all aspects of CSA.

Main Results:

• CSA is clinically classified into proximal, distal, and diffuse types based on affected muscle groups.
• Diagnosis requires evidence of muscle atrophy without sensory deficits, supported by neurological, radiological, and neurophysiological assessments.
• Key differential diagnoses include amyotrophic lateral sclerosis, Parsonage-Turner syndrome, rotator cuff tear, and Hirayama disease.

Conclusions:

• Conservative management includes cervical traction, immobilization, physical therapy, and vitamin supplementation.
• Surgical interventions are considered for cases unresponsive to conservative treatment.
• Factors predicting a poor outcome include distal-type CSA, prolonged symptoms, older age, and significant preoperative weakness.