Analysis of the Postoperative Palsy of Upper Extremities of the Cases undergone Spinous Process-Splitting Laminoplasty without Foraminotomy

Tamiya, Ado; Hanakita, Junya; Nakanishi, Kinya; Kitahama, Yoshihiro; Fukao, Shigeharu; Yoshida, Mamoru; Hirai, Tatsuo

doi:10.2531/spinalsurg.19.321

Cited by 3 publications

(4 citation statements)

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“…Tamiya et al [ 3 ] reported that direct injury or heat injury has become a cause of damage during surgery. However, Sasai et al [ 10 ] suggested that additional microcervical foraminotomy could prevent postoperative C5 palsy, although during foraminotomy high-speed drills come much closer to nerve root than any other procedure, so that frictional heat reaching the roots must be the highest.…”

Section: Discussionmentioning

confidence: 99%

“…Komagata et al [ 18 ] reported that prophylactic bilateral partial foraminotomy could reduce the incidence of C5 palsy after open-door laminoplasty from 4.0% to 0.6%. In contrast, Tamiya et al [ 3 ] reported that foraminotomy was not necessary to prevent dysfunction of the cervical nerve root. Thus, whether foraminotomy is beneficial as a prophylactic measure on the nerve root is not yet clear.…”

Section: Discussionmentioning

confidence: 99%

“…Generally, the postoperative C5 palsy is defined as muscle paresis of deltoids and biceps corresponding to the C5 segment. However, Tamiya et al [ 3 ] reported that there is also a case for ensuing pain from the C6 segment area, and participation of C6 segment as the cause for C5 palsy. Thus, we also investigated the possibility of C6 segment area being related to the C5 palsy.…”

Section: Introductionmentioning

confidence: 99%

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Risk Factor Analysis for C5 Palsy after Double-Door Laminoplasty for Cervical Spondylotic Myelopathy

et al. 2016

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Study DesignA retrospective comparative study.PurposeTo clarify the risk factors related to the development of postoperative C5 palsy through radiological studies after cervical double-door laminoplasty (DDL).Overview of LiteratureAlthough postoperative C5 palsy is generally considered to be the result of damage to the nerve root or segmental spinal cord, the associated pathology remains controversial.MethodsA consecutive case series of 47 patients with cervical spondylotic myelopathy treated by DDL at our institution between April 2008 and April 2015 were reviewed. Postoperative C5 palsy occurred in 5 of 47 cases after DDL. We investigated 9 radiologic factors that have been reported to be risk factors for C5 palsy in various studies, and statistically examined these between the two groups of palsy and the non-palsy patients.ResultsWe found a significant difference between patients with and without postoperative C5 palsy with regards to the posterior shift of spinal cord at C4/5 (p=0.008). The logistic regression analyses revealed posterior shift of the spinal cord at C4/5 (odds ratio, 12.066; p=0.029; 95% confidence interval, 1.295–112.378). For the other radiologic factors, there were no statistically significant differences between the two groups.ConclusionsIn the present study, we showed a significant difference in the posterior shift of the spinal cord at C4/5 between the palsy and the non-palsy groups, indicating that the "tethering phenomenon" was likely a greater risk factor for postoperative C5 palsy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Risk Factor Analysis for C5 Palsy after Double-Door Laminoplasty for Cervical Spondylotic Myelopathy

et al. 2016

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“…Gutter malposition refers to the gutter being too far inwards and located on the vertebral laminae rather than at the transitional zone between the vertebral laminae and the facet joint. Gutter malposition increases the risk of C 5 palsy in two ways: (I) since the thickness of the vertebral laminae is notably lower than that of the transitional zone between the vertebral laminae and the facet joint, the inner cortical bone of the vertebral laminae can be easily breached during drilling of the gutter, leading to direct injury or thermal burn to the nerve, as demonstrated in previous reports (21,22); and (II) it aggravates the excessive traction of the nerve root cuff: after the spinal canal is enlarged and re-shaped intraoperatively, the spinal cord drifts posteriorly together with the proximal end of the nerve root cuff, while the distal end of the nerve root cuff is bound between the residual laminae and OPLL foci due to the inward position of the gutter, with limited movability. This causes traction of the portion of the nerve root sleeve within the dura, which eventually leads to the symptoms of C 5 palsy (a typical case is shown in Figure 2A-2D).…”

Section: Discussionmentioning

confidence: 93%

Risk factors for C5 palsy following the posterior spinal process-splitting laminoplasty for cervical ossification of the posterior longitudinal ligament: a case control study

Zhao

et al. 2022

Ann Transl Med

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Background: Postoperative C 5 palsy is a common complication of laminoplasty for cervical ossification of the posterior longitudinal ligament (C-OPLL), although there are several hypotheses regarding its etiology, the exact pathomechanism for this undesirable event remain unclear. The aim of this study was to review clinical and imaging findings in patients with C 5 palsy and to propose potential risk factors for this complication.Methods: A total of 220 consecutive patients who had undergone posterior spinal process-splitting laminoplasty (pSPSL) for C-OPLL between January 2018 and December 2019 were included in this study.Postoperative C 5 palsy was defined as deltoid muscle weakness of a grade ≤3 in manual muscle test (MMT). These patients were divided into two groups based on the postoperative development of C 5 palsy: patients with C 5 palsy (group A) and those without C 5 palsy (group B). The clinical and imaging covariates evaluated were age, sex, OPLL type, K-line, foraminal stenosis, gutter malposition, and preoperative spinal cord signal change. Logistic regression was used to analyze the independent risk factors for C 5 palsy.Results: In total, 211 patients (18 in group A and 193 in group B) were enrolled in this study, and the incidence of C 5 palsy was 8.53%. Sixteen patients had a MMT of grade 3 and two had an MMT of grade ≤2.During the follow-up period (mean duration: 25.10±6.67 months), the MMT grade rose to 5 in 16 patients, 4 in one patient, and 3 in one patient. Multivariate analysis revealed that malposition of the bony gutter [odds ratio (OR) 11.073, 95% confidence interval (CI): 3.411, 35.948; P<0.001] and C 4/5 intervertebral foramen stenosis (OR 8.455, 95% CI: 2.559, 27.936; P<0.001) were independent risk factors for C 5 palsy. Conclusions:The incidence of C 5 palsy was 8.53% among patients undergoing pSPSL for C-OPLL.Gutter malposition and C 4/5 intervertebral foramen stenosis were identified as risk factors for this complication.

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Clinical Analysis of Operative Complications in 3,486 Spinal Surgeries performed by a Single Surgeon(<SPECIAL ISSUES>Cervical Spine)

花北

2007

Jpn J Neurosurg

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Analysis of the Postoperative Palsy of Upper Extremities of the Cases undergone Spinous Process-Splitting Laminoplasty without Foraminotomy

Cited by 3 publications

References 14 publications

Risk Factor Analysis for C5 Palsy after Double-Door Laminoplasty for Cervical Spondylotic Myelopathy

Risk Factor Analysis for C5 Palsy after Double-Door Laminoplasty for Cervical Spondylotic Myelopathy

Risk factors for C5 palsy following the posterior spinal process-splitting laminoplasty for cervical ossification of the posterior longitudinal ligament: a case control study

Clinical Analysis of Operative Complications in 3,486 Spinal Surgeries performed by a Single Surgeon(<SPECIAL ISSUES>Cervical Spine)

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