A Severe Case of Hirayama Disease Successfully Treated by Posterior Cervical Fixation without Decompression and Fusion.

Abstract

Hirayama disease (HD) is a rare disease traditionally treated with nonsurgical procedures. Surgical treatment, which is performed by decompression and/or fusion of the cervical spine, is generally considered for rapidly progressive or advanced cases, and the choice of surgical technique is debatable. We describe the first severe case of HD that was successfully treated by posterior lateral mass screw fixation without decompression or fusion. The patient was a 17-year-old adolescent boy who presented with progressive symptoms bilaterally with an unsatisfactory history of conservative treatment. We performed posterior lateral mass screw fixation without decompression or fusion and removed the internal fixation after 4 years of follow-up. Symptom remission and imaging performance improvement were achieved, and the stability and range of motion of the cervical spine were maintained. Nondecompression and nonfusion surgery was successful and achieved satisfactory results in this case; therefore, it serves as a promising candidate for the surgical treatment of HD.