C5 Palsy after Decompression Surgery for Cervical Myelopathy

Sakaura, Hironobu; Hosono, Noboru; Mukai, Yoshihiro; Ishii, Takahiro; Yoshikawa, Hideki

doi:10.1097/01.brs.0000090833.96168.3f

Cited by 354 publications

(278 citation statements)

References 21 publications

(34 reference statements)

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“…There are some common characteristics between the late postoperative neurological deficits in the present study and C5 palsy after cervical laminoplasty [24]. The common features were: (1) late onset after surgery, (2) unilateral weakness of the deltoid and biceps brachii muscles with or without sensory disturbance, and (3) preceding severe pain of the neck and scapular arch.…”

Section: Discussionsupporting

confidence: 49%

A late neurological complication following posterior correction surgery of severe cervical kyphosis

et al. 2010

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Though a possible cause of late neurological deficits after posterior cervical reconstruction surgery was reported to be an iatrogenic foraminal stenosis caused not by implant malposition but probably by posterior shift of the lateral mass induced by tightening screws and plates, its clinical features and pathomechanisms remain unclear. The aim of this retrospective clinical review was to investigate the clinical features of these neurological complications and to analyze the pathomechanisms by reviewing pre-and post-operative imaging studies. Among 227 patients who underwent cervical stabilization using cervical pedicle screws (CPSs), six patients who underwent correction of cervical kyphosis showed postoperative late neurological complications without any malposition of CPS (ND group). The clinical courses of the patients with deficits were reviewed from the medical records. Radiographic assessment of the sagittal alignment was conducted using lateral radiographs. The diameter of the neural foramen was measured on preoperative CT images. These results were compared with the other 14 patients who underwent correction of cervical kyphosis without late postoperative neurological complications (non-ND group). The six patients in the ND group showed no deficits in the immediate postoperative periods, but unilateral muscle weakness of the deltoid and biceps brachii occurred at 2.8 days postoperatively on average. Preoperative sagittal alignment of fusion area showed significant kyphosis in the ND group. The average of kyphosis correction in the ND was 17.6°per fused segment (range 9.7°-35.0°), and 4.5°( range 1.3°-10.0°) in the non-ND group. A statistically significant difference was observed in the degree of preoperative kyphosis and the correction angles at C4-5 between the two groups. The diameter of the C4-5 foramen on the side of deficits was significantly smaller than that of the opposite side in the ND group. Late postoperative neurological complications after correction of cervical kyphosis were highly associated with a large amount of kyphosis correction, which may lead foraminal stenosis and enhance posterior drift of the spinal cord. These factors may lead to both compression and traction of the nerves, which eventually cause late neurological deficits. To avoid such complications, excessive kyphosis correction should not be performed during posterior surgery to avoid significant posterior shift of the spinal cord and prophylactic foraminotomies are recommended if narrow neuroforamina were evident on preoperative CT images. Regardless of revision decompression or observation, the majority of this late neurological complication showed complete recovery over time.

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Section: Discussionsupporting

confidence: 49%

A late neurological complication following posterior correction surgery of severe cervical kyphosis

et al. 2010

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“…This technique is well established and the reported complication rates are acceptable, but some problems such as axial symptoms or C5 palsy have not been fully resolved [4][5][6]. The long term results of this technique is satisfactory, with the preservation of the enlarged cervical canal area and the maintenance of JOA scores for cervical myelopathy (JOA score, Table 1, maximum score 17 points) [7].…”

Section: Introductionmentioning

confidence: 99%

Clinical results of and patient satisfaction with cervical laminoplasty for considerable cord compression with only slight myelopathy

et al. 2011

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Purpose There is no established consensus on the indications for surgery in patients with considerable cord compression but only slight myelopathy. The purpose of this study is to stimulate discussion about the indications for surgery in these patients. Methods The records of consecutive patients who underwent cervical laminoplasty (CLP) during 3.5 years were reviewed. Those patients whose pre-operative Japanese Orthopaedic Association score (JOA score, maximum 17) for cervical myelopathy was 16 points or more, indicating that they had very slight myelopathy, were selected. The postoperative JOA scores of these patients were checked via a chart review, and they were sent a survey asking about their degree of satisfaction with the results of surgery.

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“…It has also been reported after other posterior-based techniques. The incidence varies from 0-50% depending on the technique used, how the condition is defined and which patient group is being analysed [3,[4][5][6][7][8]9,10]. Takemitsu et al [11] reported a higher incidence among patients undergoing instrumentation than those treated by laminoplasty alone.…”

Section: Introductionmentioning

confidence: 99%

“…Several etiologies have been proposed to explain this phenomenon including direct root injury, posterior spinal cord drift, spinal cord ischemia, reperfusion injury and segmental cord affection [4,[7][8][9]. Additional instrumentation is suspected of increasing the incidence of C5 palsy through iatrogenic foraminal stenosis [12,5,6,10] and added tension in the spinal cord and roots caused by correcting the spinal alignment [6,10].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Surgical Management of C5 Palsy Resulting from Posterior Spinal Decompression for the Treatment of Cervical Spondylotic Myelopathy

Saoud¹

2013

J Spine

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Objective: To assess the feasibility of anterior cervical procedures in the treatment of C5 palsy occurring after posterior cervical decompression procedures done for the treatment of cervical spondylotic myelopathy. Introduction:In this study we hypothesized that anterior cervical decompression would benefit these patients through widening the cervical foramen, directly by rongeurs and drills and indirectly by placing an intervertebral spacer (cervical cage). The aim of the study is to assess whether a more proactive approach would benefit these patients.

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C5 Palsy after Decompression Surgery for Cervical Myelopathy

Cited by 354 publications

References 21 publications

A late neurological complication following posterior correction surgery of severe cervical kyphosis

A late neurological complication following posterior correction surgery of severe cervical kyphosis

Clinical results of and patient satisfaction with cervical laminoplasty for considerable cord compression with only slight myelopathy

Surgical Management of C5 Palsy Resulting from Posterior Spinal Decompression for the Treatment of Cervical Spondylotic Myelopathy

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