Yamada T, et al. - Via a multicenter retrospective analysis of 43 cases, the researchers compared surgical outcomes among different approaches and analyzed the factors related to poor outcomes (manual muscle test [MMT] improvement ≤ 0) following surgery in distal-type cervical spondylotic amyotrophy (CSA, a rare form of cervical spondylosis that causes muscle weakness of upper extremities) patients. The pathophysiology of CSA was frequently generated by a combination of multiple lesions in the anterior horn and/or nerve root. Nineteen of 29 patients who received anterior approach methods were involved in the good outcome group (MMT improvement ≥ 1), whereas 7 of 14 patients (50.0%) in the posterior group were categorized as good. Regardless of the higher rate of complications, the mean MMT grade significantly improved from 2.6 to 3.4 in the anterior group. The term of symptoms was substantially correlated with poor outcomes. In the < 6 months group, the MMT grade significantly improved from 2.2 to 3.2. Cervical alignments and preoperative MMT grade were not statistically correlated with poor outcomes. Hence, subjects with poor outcomes had symptoms for a more prolonged span. Tolerable clinical outcomes within 6 months from the onset were ascertained. Furthermore, since the anterior approaches markedly enhanced MMT levels in the hands, this procedure might be suggested.