Amyotrophic lateral sclerosis (ALS) is a progressive developmental degenerative disease involving the upper and lower motor nervous system. Patients often start with weakness and atrophy of the small muscles of the hands, which gradually progress to the extremities, ball and respiratory muscles. Patients most often die of respiratory failure. The clinical manifestations of ALS are mainly lower motor unit symptoms such as weakness, atrophy and fasciculations of the limbs and upper motor unit symptoms such as spastic gait, hyperreflexia and pathological signs. Since ALS has no specific laboratory features, the diagnosis is based on clinical symptoms and signs. In addition, because the disease is rare and other diseases need to be excluded, the early misdiagnosis rate can be as high as 40% and can be easily misdiagnosed as spinal cervical spondylosis (CSM), multifocal motor neuropathy, etc. In the early stages of ALS, the disease can be more similar to CSM: 1) the average age of onset of ALS is 55.7 years, which is similar to that of CSM, and the incidence of CSM is high and more common clinically; 2) CSM can also present with increased muscle tone in the lower extremities such as weakness, atrophy and gait instability in the upper extremities, and although typical CSM can have sensory symptoms such as radicular pain and sphincter disorders, there are 3) CSM can also show extensive neurogenic damage in the limbs during electrophysiological examination. 4) Most patients with CSM have a long disease duration, but the disease can progress acutely over a period of time, which makes it difficult to differentiate between the two. There is no effective treatment for ALS, and the decision to operate for CSM generally depends on the following points: 1) whether the patient’s symptoms and signs are consistent with the severity of the imaging damage; 2) whether the patient’s lesions are progressive; 3) whether conventional conservative treatment (drugs, physiotherapy, traction, etc.) is ineffective. ) are ineffective. In general, it is still debated whether surgery is ultimately beneficial, because a proportion of patients with CSM tend to spontaneously resolve after progressive progression and do not require surgical treatment, and because some studies have shown that surgery does not result in an improvement in neurological function scores at 3 years, but only in some degree of symptomatic relief. Therefore, the surgical approach and timing of CSM must be chosen carefully, especially for patients with no sensory impairment and more severe muscle atrophy and fasciculations, and other diseases such as ALS and MS need to be fully excluded before making a decision. Currently, orthopedic surgeons are conscious of the need to perform electromyography and nerve conduction velocity in CSM patients with atypical clinical symptoms in order to identify them, but there are still questions about whether to perform surgery in patients with early ALS or in patients with co-morbid CSM and ALS. Previous studies have often suggested that surgical treatment can aggravate ALS patients and cause a rapid deterioration of their symptoms. However, recent studies have shown that surgery early in the course of ALS does not reduce survival time compared to typical ALS, although the disease continues to progress. In this paper, we will retrospectively analyze typical ALS patients in our hospital and will compare the epidemiological characteristics, disease progression, and survival outcomes of patients who underwent cervical spine surgery after the onset of ALS with those of typical ALS patients, so as to objectively evaluate the impact of cervical spine surgery on disease progression and prognosis of ALS. Subjects and methods I. I. Study population and grouping: Retrospective analysis of 329 outpatients and inpatients with ALS at our hospital from January 2000 to January 2007, all of whom met the criteria for confirmed or proposed ALS according to the modified El Escorial diagnostic criteria, and each patient recorded medical history, epidemiology, cervical spine MRI findings and surgical history and modified ALS functional class scale score ( ALSFRS-R), etc. There were 19 patients who underwent cervical spine surgery after the onset of ALS, hereinafter referred to as the operated group, and 92 consecutive patients who had not undergone surgery from September 2003 to September 2005, hereinafter referred to as the non-operated ALS group. For this group, in addition to baseline documentation, we conducted face-to-face or telephone follow-up visits every three months until June 2007, when death or tracheotomy or mechanically ventilated assisted breathing was considered an endpoint event. Patients were considered as truncated data if they were missed, died unanticipated and survived beyond the observation time. The ALSFRS-R replaced the original respiratory function score, which was only one item, and increased it to 12 points for three items. The total score is 48 points for 12 items. Thus, the ALSFRS-R includes four major components: 1) ball function, 2) upper extremity function, 3) lower extremity function, and 4) respiratory function. In estimating the patient’s progression at diagnosis (△FS1), we invoked the concept of linear rate of change proposed by Amonc, which means that a certain observation recorded at diagnosis is assumed to be the result after a uniform change from the onset to the time point of recording, and the slope of the linear decline is calculated and called the linear rate of change estimate. For example, the linear rate of change estimate of ALSFRS-R △FS = (48- ALSFRS-R at diagnosis)/time from onset to diagnosis. This method is now widely used internationally. The rate of progression of the patient’s disease after diagnosis (△FS2) we took one year as the boundary, △FS2= (ALSFRS-R at diagnosis – ALSFRS-R one year after diagnosis)/12 months, if the patient’s observation time was less than 12 months, the last observation value and the corresponding observation time were used instead. III. Statistical methods: Count data were expressed as rate (%) using chi-square test; measurement data were expressed as mean ± standard deviation (X ± s), and those conforming to normal distribution were analyzed by ANOVA and t-test, respectively, and those with non-normal distribution were subjected to Mann-Whitney U test of non-parametric test; median survival time was calculated by KaplanCMeier, and log-rank analysis of each single The median survival time was calculated by KaplanCMeier, and the relationship between each single factor variable and survival time was analyzed by log-rank. Cox risk proportional model was used to analyze the effect of multiple variables on survival time and to select statistically significant predictors of survival time. All data were calculated by the SPSS 10.0 for Windows package. Results I: Clinical data: Surgical group: Among 329 typical ALS patients, cervical spine MRI showed cervical disc herniation, calcification of the posterior longitudinal ligament and other deformation of the dural sac spinal cord with different degrees of compression, accounting for 47.4% of the total number of patients, of which 19 patients (5.78% of the total number) underwent cervical spine surgery (surgical group). The age of onset ranged from 45 to 76 years, with a mean of (55.11±8.92) years; the duration of the disease ranged from 4 to 49 months, with a mean of (22.84±11.25) months. The time from onset to surgery ranged from 1 to 30 months, with a mean of (11.47±7.15) months, and the time from onset to diagnosis ranged from 12 to 36 months, with a mean of (23±6.51) months. Neurological function scores at diagnosis ranged from 27 to 43, with a mean of (35.26±5.01). The disease started in the upper extremity in 13 cases (68.42%), in the lower extremity in 5 cases (26.32%), and in both the upper and lower extremities in 1 case (5.2%). None of the patients developed symptoms in the ball region, but the ball region was involved in 12 cases (63.16%) at the time of diagnosis. There were 5 patients who underwent surgery for unilateral hand weakness and atrophy, 2 patients who underwent surgery for upper limb lifting weakness and atrophy, 3 patients who underwent surgery for both proximal and distal upper limb muscle involvement, 1 patient who underwent surgery for lower limb weakness and easy to fall, 5 patients who underwent surgery for lateral weakness and atrophy, 5 patients who underwent surgery for limb weakness and atrophy, 4 patients with pain or sensory disturbance, and 1 patient One patient had a history of cervical spine trauma. The condition of all patients progressed after surgery, among which 7 patients (36.84%) had significant progression of symptoms after surgery, 6 patients (31.58%) had no significant change in symptoms after surgery, and 6 patients (31.58%) had mild relief of symptoms after surgery, which continued to worsen after a period of time. The clinical data of the non-operated group are compared with those of the operated group in Table 1. It can be seen that there was no significant difference in the age at onset, gender composition, and neurological function score of the two groups compared at the time of diagnosis (P > 0.05). However, the time from onset to diagnosis was significantly longer in the operated group than in the non-operated group (P < 0.001). And the proportion of ball symptoms at the time of diagnosis was significantly greater in the non-operated group (P < 0.05). Comparison of clinical data between the cervical spine surgery group and the non-operated group in patients with confirmed and proposed ALS The surgical group non-operated group value Gender (male/female Age of onset (years Proportion of diagnosed ball involvement Time to confirmed diagnosis (months