Amyotrophic Lateral Sclerosis (ALS) and Cervical Spondylosis/Cervical Spondylotic Myelopathy (CS/CSM): experience in a Referral Centre in Argentina

GARGIULO MONACHELLI GM; RODRIGUEZ G; BETTINI M; REY RC; SICA REP

Napoles, Italia

Congreso; XII International Congress on Neuromuscular Diseases. Napoles, Italia. 17-22 julio 2010.; 2010

Title: Amyotrophic Lateral Sclerosis (ALS) and Cervical Spondylosis/Cervical Spondylotic Myelopathy (CS/CSM): experience in a Referral Centre in Argentina.   Background: CS/CSM may not only be a differential diagnosis for ALS, but may also coexist with the disease. Indeed, it is also considered a risk factor for ALS.   Objectives: To determine incidence, risk and severity of CS/CSM and spinal surgery among ALS and non ALS patients. To compare demographic characteristics and survival in ALS patients according to spondylotic pathology.   Methods: Retrospective review of medical records yielded 278 patients consulting for motor neuron (MN) symptoms and signs. We considered 203 ALS and 75 non ALS patients (CS/CSM or other neuromuscular disorders); history of spinal surgery and MRI data. We classified cervical narrowing into: Grade 1, mild without cord compression (CC); G2, moderate with CC and G3, severe with CC or increased signal intensities. We divided ALS into: ALS+CS/CSM, ALS+other spondylotic pathology (OSP), and ALS without OSP.   Results: Among ALS, 20% had CS/CSM compared to 27% of non ALS. Inversely, 43% of ALS had OSP compared to 25% of non ALS patients (p=0.03). The majority of ALS had G1 and of non ALS G3 findings. Spinal surgery was performed in 1% of ALS versus 9.4% of non ALS (p=0.0005). Likewise, 0% of ALS and 71.4% of non ALS surgeries provided benefit (p=0.0002). Among the 3 ALS groups, ALS+CS/CSM had an older age (ANOVA, p=0.002), a 2.5-fold-increase of male predominance, higher percentage of pain as first symptom and briefer survival.   Conclusion: We found a similar incidence of CS/CSM among ALS and non ALS patients, but an increase of OSP in the former. 1% of ALS patients had undergone spinal surgery. ALS+CS/CSM involved risk factors for both diseases (age-gender) and could represent a worse prognosis group.