Hirayama Disease as a rare cause of cervical myelopathy of the young. A meta-analysis comparing conservative and surgical treatment

Background: Hirayama disease is a rare form of cervical myelopathy exacerbated by flexion-extension movements of the neck. It affects mainly young male patients. The scarcity of cases implies uncertainty when it comes to choose the best treatment between conservative and surgical approach. Methods: A systematic review of the current literature was performed following the PRISMA guidelines. A meta-analytic comparison of patients’ outcome in terms of clinical and radiological data has derived. Results: From our meta-analysis, clinical and radiological improvement was obtained in both surgical and conservative treatment, with different percentages. Radiological improvement was seen in 91% of the population undergoing surgical treatment vs 57% of conservative treatment. Moreover, clinical improvement was obtained in 92% of surgical patients vs 78% of patients wearing a collar. Our hypothesis is related to the compliance of patients forced to wear a cervical collar 24h a day for 2-3 years. Conclusions: While findings from pertinent literature are conflicting, results from our meta-analysis seems to lean on surgical treatment as best alternative to offer clinical and radiological improvements (92% and 91%, respectively). our study hint both surgery and conservative management as equally valuable. Nevertheless, conservative treatment is able to achieve clinical and radiological improvement in 78% and 57% of patients respectively.