Risk Factors and Prevention of C5 Palsy After Anterior Cervical Decompression and Fusion

Abstract

Objective: The objective of this study was to review clinical and imaging findings after anterior cervical decompression and fusion, as a basis for prevention of C5 palsy.Summary of Background Data: C5 palsy is a common postoperative complication in spine surgery, but the mechanistic basis for this condition is unknown. Materials and Methods:The subjects were 239 patients with cervical myelopathy who underwent anterior cervical decompression and fusion including at C4-C5 disk level at our hospital from 2001 to 2018. Twelve of these patients (5.0%) had C5 palsy postoperatively. Clinical features and imaging findings were compared in patients with and without C5 palsy. Results:In patients with C5 palsy, the sagittal alignment of the cervical spine was kyphotic, the width of the C5 intervertebral foramen was narrower, and the lateral decompressed line was wider beyond the medial part of the Luschka joint. Age, sex, disease, the number of fused segments, decompression width, and anterior shift of the spinal cord did not differ significantly between patients with and without C5 palsy.Conclusions: These results indicate that the pathomechanism of C5 palsy may be dependent on the location of the lateral decompression line, especially in patients with cervical kyphosis and a narrow C5 intervertebral foramen. Excessive lateral decompression beyond the Luchka joint might lead to C5 root kinking between the intervertebral foramen and posterior edge of vertebra. This pathomechanism may be similar in anterior and posterior approaches. To prevent C5 palsy, the medial line of the Luschka joint should be confirmed intraoperatively and decompression should be performed within the Luschka joints. Alternatively, medial foraminotomy should be used in cases needing wide decompression, such as those with massive ossification of the posterior longitudinal ligament, lateral osteophytes, and symptomatic foraminal stenosis.

Network Meta-analysis of C5 Palsy after Anterior Cervical Decompression of 3-6 Levels

“…Recent studies assessing radiological findings strongly suggest that the postoperative shift of the spinal cord-induced nerve root traction and/or tethering is associated with both posterior and anterior approaches. 5,9,39,40 We previously reported a meta-analysis comparing the risk of C5 palsy among 3 anterior procedures involving 3 or more IVLs (2 or more consecutive corpectomies). We found that ACDF may yield better outcomes than hybrid and ACCF, 6 even though there was no significant difference in risk between ACDF and ACCF after decompression for 1 to 2 IVLs.…”

“…The pathomechanism of C5 palsy remains unclear. Recent studies assessing radiological findings strongly suggest that the postoperative shift of the spinal cord-induced nerve root traction and/or tethering is associated with both posterior and anterior approaches 5,9,39,40 . We previously reported a meta-analysis comparing the risk of C5 palsy among 3 anterior procedures involving 3 or more IVLs (2 or more consecutive corpectomies).…”

Intervertebral Canals and Intracanal Ligaments as New Terms in Terminologia anatomica

“…It is known that narrowing of the medial and lateral intervertebral aperture or the entire intervertebral canal, especially in cases of osteophyte overgrowth, leads to a reduction in the reserve space and squeezing of the roots, nerves, vessels and other anatomical elements passing through them, which promotes the development of severe pathological conditions. This is evidenced, for example, by the occurrence of cervical spondylotic myelopathy or spinal nerve palsy after an anterior cervical discectomy in patients with a narrow intervertebral foramen [24,25]. In addition, the presence of other pathogenetic factors in such patients (hormonal, metabolic or traumatic factors) may cause edema of connective tissue structures and the further narrowing of the already limited space.…”

Injeção em camundongos de células-tronco mononucleares de cordão umbilical e placenta humana após 3 a 6 semanas de lesão medular espinhal experimental

“…Takahashi et al 90 , em estudo realizado com ratos e com células mesenquimais advindas de tecido adiposo, encontraram melhora histológica com transplante de células-tronco associado ou não ao exercício, com menor formação de escara e cavidade no sítio da lesão com 4 semanas do trauma. Apesar da melhora histológica ter ocorrido realizando ou não exercícios, a melhora motora só ocorreu nos ratos que realizaram programa de exercício.…”