Cervical Flexor–Extensor Muscle Disparity in Monomelic Amyotrophy (Hirayama Disease): Evidence from a Comprehensive Morphometric Evaluation of Subaxial Paraspinal Musculature

Sumit Thakar; Niranjana Rajagopal; Prashanth Alle; Saritha Aryan; Alangar Hegde

doi:10.1055/s-0042-1749111

Asian Journal of Neurosurgery, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · Asian J Neurosurg 2022; 17(01): 068-073
DOI: 10.1055/s-0042-1749111

Original Article

Cervical Flexor–Extensor Muscle Disparity in Monomelic Amyotrophy (Hirayama Disease): Evidence from a Comprehensive Morphometric Evaluation of Subaxial Paraspinal Musculature

Sumit Thakar

¹Department of Neurological Sciences, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, Karnataka, India

,

Niranjana Rajagopal

¹Department of Neurological Sciences, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, Karnataka, India

,

Prashanth Alle

¹Department of Neurological Sciences, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, Karnataka, India

,

Saritha Aryan

¹Department of Neurological Sciences, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, Karnataka, India

,

Alangar Hegde

¹Department of Neurological Sciences, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, Karnataka, India

› Institutsangaben

Abstract

Background Monomelic amyotrophy (Hirayama disease) has been established to have accompanied biomechanical abnormalities such as flexion hypermobility and sagittal imbalance. Paraspinal muscles, the major contributor to cervical biomechanics, have, however, not been comprehensively evaluated in the disease. The objective of this study was to compare the morphology of the subaxial cervical paraspinal musculature in patients with and without Hirayama disease.

Materials and Methods A retrospective case-control study of 64 patients with Hirayama disease and 64 age- and sex-matched controls was performed. Cross-sectional areas (CSAs) of the superficial and deep flexors and extensors from C3 to C7 were measured on T2-weighted magnetic resonance imaging sequences. Student's t-test was used to compare differences between the paraspinal muscle CSAs in the study and control groups.

Results Compared with controls, patients with Hirayama disease were found to have larger flexors and smaller extensors at all levels. The overall subaxial muscle area values for superficial flexors and deep flexors were significantly larger (p < 0.0001) in patients, while the corresponding superficial extensor and deep extensor area values were significantly smaller than in controls (p = 0.01 and < 0.0001, respectively). The patient group demonstrated stronger subaxial deep flexor–deep extensor, superficial flexor–superficial extensor, and total flexor–total extensor ratios (p < 0.0001).

Conclusion Patients with Hirayama disease have morphometric alterations at all levels of their subaxial cervical paraspinal musculature. These patients have abnormally large flexors and small extensors compared with controls. This flexor–extensor muscle disparity could be utilized as a potentially modifiable factor in the management of the disease.

Keywords

Hirayama disease - paraspinal muscles - morphometric - flexor–extensor disparity

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References
1 Hirayama K, Tokumaru Y. Cervical dural sac and spinal cord in juvenile muscular atrophy of distal upper extremity. Neurology 2000; 54 (10) 1922-1926
2 Tashiro K, Kikuchi S, Itoyama Y. et al. Nationwide survey of juvenile muscular atrophy of distal upper extremity (Hirayama disease) in Japan. Amyotroph Lateral Scler 2006; 7 (01) 38-45
3 Watanabe K, Hasegawa K, Hirano T, Endo N, Yamazaki A, Homma T. Anterior spinal decompression and fusion for cervical flexion myelopathy in young patients. J Neurosurg Spine 2005; 3 (02) 86-91
4 Huang YL, Chen CJ. Hirayama disease. Neuroimaging Clin N Am 2011; 21 (04) 939-950 , ix–x
5 Lai V, Wong YC, Poon WL, Yuen MK, Fu YP, Wong OW. Forward shifting of posterior dural sac during flexion cervical magnetic resonance imaging in Hirayama disease: an initial study on normal subjects compared to patients with Hirayama disease. Eur J Radiol 2011; 80 (03) 724-728
6 Panjabi MM, Cholewicki J, Nibu K, Grauer J, Babat LB, Dvorak J. Critical load of the human cervical spine: an in vitro experimental study. Clin Biomech (Bristol, Avon) 1998; 13 (01) 11-17
7 Li Z, Zhang W, Wu W, Wei C, Chen X, Lin J. Is there cervical spine muscle weakness in patients with Hirayama disease? A morphological study about cross-sectional areas of muscles on MRI. Eur Spine J 2020; 29 (05) 1022-1028
8 Hirayama K. [Juvenile muscular atrophy of unilateral upper extremity (Hirayama disease)–half-century progress and establishment since its discovery]. Brain Nerve 2008; 60 (01) 17-29
9 Hirayama K, Tomonaga M, Kitano K, Yamada T, Kojima S, Arai K. Focal cervical poliopathy causing juvenile muscular atrophy of distal upper extremity: a pathological study. J Neurol Neurosurg Psychiatry 1987; 50 (03) 285-290
10 Kleinbaum DG, Sullivan KM, Barker ND. . Matching-Seems Easy, But not that Easy. A Pocket Guide to Epidemiology. 2007: 257-275
11 Elliott J, Jull G, Noteboom JT, Darnell R, Galloway G, Gibbon WW. Fatty infiltration in the cervical extensor muscles in persistent whiplash-associated disorders: a magnetic resonance imaging analysis. Spine 2006; 31 (22) E847-E855
12 Thakar S, Mohan D, Furtado SV. et al. Paraspinal muscle morphometry in cervical spondylotic myelopathy and its implications in clinicoradiological outcomes following central corpectomy: clinical article. J Neurosurg Spine 2014; 21 (02) 223-230
13 Kikuchi S, Tashiro K, Kitagawa M, Iwasaki Y, Abe H. [A mechanism of juvenile muscular atrophy localized in the hand and forearm (Hirayama's disease)–flexion myelopathy with tight dural canal in flexion]. Rinsho Shinkeigaku 1987; 27 (04) 412-419
14 Khadilkar S, Patel B, Bhutada A, Chaudhari C. Do longer necks predispose to Hirayama disease? A comparison with mimics and controls. J Neurol Sci 2015; 359 (1-2): 213-216
15 Ciceri EF, Chiapparini L, Erbetta A. et al. Angiographically proven cervical venous engorgement: a possible concurrent cause in the pathophysiology of Hirayama's myelopathy. Neurol Sci 2010; 31 (06) 845-848
16 Ding Y, Rong D, Wang X, Li C. [To evaluate the cervical spine curvature and growth rate for studying the pathogenesis of Hirayama disease in adolescents]. Zhonghua Nei Ke Za Zhi 2015; 54 (08) 721-724
17 Xu X, Han H, Gao H. et al. The increased range of cervical flexed motion detected by radiographs in Hirayama disease. Eur J Radiol 2011; 78 (01) 82-86
18 Liu X, Sun Y. The correlation analysis of the cervical spine alignment flexion ROM of adjacent segments with the spinal cord atrophy in Hirayama disease. Zhongguo Jizhu Jisui Zazhi 2013; 23: 514-519
19 Song J, Cui ZY, Chen ZH, Jiang JY. Analysis of the effect of surgical treatment for the patients with Hirayama disease from the perspective of cervical spine sagittal alignment. World Neurosurg 2020; 133: e342-e347
20 Goel A, Dhar A, Shah A. Multilevel spinal stabilization as a treatment for Hirayama disease: report of an experience with five cases. World Neurosurg 2017; 99: 186-191
21 Blazevich AJ, Coleman DR, Horne S, Cannavan D. Anatomical predictors of maximum isometric and concentric knee extensor moment. Eur J Appl Physiol 2009; 105 (06) 869-878
22 Okada E, Matsumoto M, Ichihara D. et al. Cross-sectional area of posterior extensor muscles of the cervical spine in asymptomatic subjects: a 10-year longitudinal magnetic resonance imaging study. Eur Spine J 2011; 20 (09) 1567-1573
23 Elliott JM, Jull GA, Noteboom JT, Durbridge GL, Gibbon WW. Magnetic resonance imaging study of cross-sectional area of the cervical extensor musculature in an asymptomatic cohort. Clin Anat 2007; 20 (01) 35-40
24 Takeuchi K, Yokoyama T, Aburakawa S. et al. Axial symptoms after cervical laminoplasty with C3 laminectomy compared with conventional C3-C7 laminoplasty: a modified laminoplasty preserving the semispinalis cervicis inserted into axis. Spine 2005; 30 (22) 2544-2549
25 Cheng CH, Lin KH, Wang JL. Co-contraction of cervical muscles during sagittal and coronal neck motions at different movement speeds. Eur J Appl Physiol 2008; 103 (06) 647-654
26 Cheng CH, Cheng HY, Chen CP. et al. Altered Co-contraction of cervical muscles in young adults with chronic neck pain during voluntary neck motions. J Phys Ther Sci 2014; 26 (04) 587-590
27 Lee PJ, Rogers EL, Granata KP. Active trunk stiffness increases with co-contraction. J Electromyogr Kinesiol 2006; 16 (01) 51-57
28 Gardner-Morse MG, Stokes IA. Trunk stiffness increases with steady-state effort. J Biomech 2001; 34 (04) 457-463
29 Crisco JJ, Panjabi MM, Yamamoto I, Oxland TR. Euler stability of the human ligamentous lumbar spine. Part II: Experiment. Clin Biomech (Bristol, Avon) 1992; 7 (01) 27-32
30 Lindstrøm R, Schomacher J, Farina D, Rechter L, Falla D. Association between neck muscle coactivation, pain, and strength in women with neck pain. Man Ther 2011; 16 (01) 80-86
31 Lehman VT, Luetmer PH, Sorenson EJ. et al. Cervical spine MR imaging findings of patients with Hirayama disease in North America: a multisite study. AJNR Am J Neuroradiol 2013; 34 (02) 451-456
32 Gupta K, Sood S, Modi J, Gupta R. Imaging in Hirayama disease. J Neurosci Rural Pract 2016; 7 (01) 164-167
33 Alpayci M, Şenköy E, Delen V. et al. Decreased neck muscle strength in patients with the loss of cervical lordosis. Clin Biomech (Bristol, Avon) 2016; 33: 98-102
34 Agundez M, Rouco I, Barcena J, Mateos B, Barredo J, Zarranz JJ. Hirayama disease: Is surgery an option?. Neurologia 2015; 30 (08) 502-509
35 Tokumaru Y, Hirayama K. [Cervical collar therapy for juvenile muscular atrophy of distal upper extremity (Hirayama disease): results from 38 cases]. Rinsho Shinkeigaku 2001;41(4–5):173–178 (Japanese)
36 Fu Y, Qin W, Sun QL, Fan DS. [Investigation of the compliance of cervical collar therapy in 73 patients with Hirayama disease]. Zhonghua Yi Xue Za Zhi 2016; 96 (43) 3485-3488
37 Sarma AD, Devi M. Physical therapy for Hirayama disease: is the evidence bending towards or away from flexion?. Indian J Appl Res 2019; 9: 40-41