Can Prophylactic Bilateral C4/C5 Foraminotomy Prevent Postoperative C5 Palsy After Open-Door Laminoplasty?

Katsumi, Keiichi; Yamazaki, A.; Watanabe, Kei; Ohashi, Masayuki; Shoji, Hirokazu

doi:10.1097/brs.0b013e3182326957

Cited by 97 publications

(66 citation statements)

References 19 publications

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“…21 Katsumi et al advocate prophylactic foraminotomy to decrease the incidence of C-5 palsy. 16 However, foraminotomy reduces the amount of bone available for screw purchase and may adversely impact overall stability. The machined interfacet allograft spacer is a facet distraction device with a large surface area that provides solid support for the spinal column and distracts the facet joint, thereby stiffening the spinal segment, which should facilitate arthrodesis.…”

Section: Discussionmentioning

confidence: 99%

Effect of machined interfacet allograft spacers on cervical foraminal height and area

Tan

Gerard

Anderson

et al. 2014

SPI

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Object Iatrogenic foraminal stenosis is a well-known complication in cervical spine surgery. Machined interfacet allograft spacers can provide a large surface area, which ensures solid support, and could potentially increase foraminal space. The authors tested the hypothesis that machined interfacet allograft spacers increase cervical foraminal height and area. Methods The C4–5, C5–6, and C6–7 facets of 4 fresh adult cadavers were exposed, and the cartilage was removed from each facet using customized rasps. Machined allograft spacers were tamped into the joints. The spines were scanned with the O-arm surgical imaging system before and after placement of the spacers. Two individuals independently measured foraminal height and area on obliquely angled sagittal images. Results Foraminal height and area were significantly greater following placement of the machined interfacet spacers at all levels. The Pearson correlation between the 2 radiographic reviewers was very strong (r = 0.971, p = 0.0001), as was the intraclass correlation coefficient (ICC = 0.907, p = 0.0001). The average increase in foraminal height was 1.38 mm. The average increase in foraminal area was 18.4% (0.097 mm2). Conclusions Modest distraction of the facets using machined interfacet allograft spacers can increase foraminal height and area and therefore indirectly decompress the exiting nerve roots. This technique can be useful in treating primary foraminal stenosis and also for preventing iatrogenic foraminal stenosis that may occur when the initially nonlordotic spine is placed into lordosis either with repositioning after central canal decompression or with correction using instrumentation. These grafts may be a useful adjunct to the surgical treatment of cervical spine disease.

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Section: Discussionmentioning

confidence: 99%

Effect of machined interfacet allograft spacers on cervical foraminal height and area

Tan

Gerard

Anderson

et al. 2014

SPI

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“…16,[20][21][22][23] However, another five studies found no relation between age and the development of C5 palsy after surgery. 2,5,[24][25][26] None of these studies further analyzed the relationship between this potential risk factor and C5 palsy development.…”

Section: Risk Factorsmentioning

confidence: 99%

C5 nerve root palsy after posterior cervical spine surgery

Fang

Wang

et al. 2017

J Orthop Surg (Hong Kong)

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Background: C5 palsy is a serious complication after cervical decompression surgery in which the patient shows a deterioration in power of the deltoid or biceps brachii by at least one grade in the manual muscle test without aggravation of lower extremity function. Although there are several hypotheses regarding the etiology of C5 palsy, the pathogenesis and preventive measures remain unidentified and many other controversies remain. Objective: To systematically review the clinical features, risk factors, mechanism, and preventive measures of C5 palsy after posterior cervical decompression surgery. Materials and methods: PubMed was searched to identify eligible studies that contained more than 10 cases and focused on C5 palsy. Microsoft Excel was used to analyze the data. Statistical comparisons were made when appropriate. Results: Out of 718 papers involving C5 palsy, 28 met the inclusion criteria. The average incidence rate was 7.8% (range, 1.4-23.0%). Risk factors for C5 palsy included age, male gender, ossification of the posterior longitudinal ligament, and stenosis of the C4-C5 intervertebral foramen. C5 palsy occurred from immediately to 2 months after surgery, and recovery time ranged from 48 h to 41 months. Hypotheses for the mechanism of C5 palsy included root involvement and spinal cord impairment. Foraminotomy and intraoperative neuromonitoring were the two main methods used to prevent C5 palsy. Conclusion: C5 palsy is a serious complication occurring at the early stage after cervical decompression surgery. Foraminotomy and intraoperative neuromonitoring were the two main methods to prevent C5 palsy. The incidence of C5 palsy is low, but it can place a serious burden on the patients' quality of life and finances. The risk factors and mechanism of C5 palsy are still controversial. However, under conservative therapy, the prognosis is usually good. Higher quality studies are necessary for drawing more reliable and convincing conclusions about this disease.

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“…47,63 In addition, 11 studies compared laminoplasty techniques or considered technical differences such as laminoplasty with and without foraminotomy or muscle preservation. 28,29,34,38,39,43,57,58,60,66,71 …”

Section: Study Characteristicsmentioning

confidence: 99%

A systematic review of clinical and surgical predictors of complications following surgery for degenerative cervical myelopathy

Tetreault

Ibrahim

Côté

et al. 2016

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OBJECT Although generally safe and effective, surgery for the treatment of cervical spondylotic myelopathy (CSM) is associated with complications in 11%–38% of patients. Several predictors of postoperative complications have been proposed but few are used to detect high-risk patients. A standard approach to identifying “at-risk” patients would improve surgeons’ ability to prevent and manage these complications. The authors aimed to compare the complication rates between various surgical procedures used to treat CSM and to identify patient-specific, clinical, imaging, and surgical predictors of complications. METHODS The authors conducted a systematic review of the literature and searched MEDLINE, MEDLINE in Process, EMBASE, and Cochrane Central Register of Controlled Trials from 1948 to September 2013. Cohort studies designed to evaluate predictors of complications and intervention studies conducted to compare different surgical approaches were included. Each article was critically appraised independently by 2 reviewers, and the evidence was synthesized according to the principles outlined by the Grading of Recommendation Assessment, Development and Evaluation (GRADE) Working Group. RESULTS A total of 5472 citations were retrieved. Of those, 60 studies met the inclusion criteria and were included in the review. These studies included 36 prognostic cohort studies and 28 comparative intervention studies. High evidence suggests that older patients are at a greater risk of perioperative complications. Based on low evidence, other clinical factors such as body mass index, smoking status, duration of symptoms, and baseline severity score, are not predictive of complications. With respect to surgical factors, low to moderate evidence suggests that estimated blood loss, surgical approach, and number of levels do not affect rates of complications. A longer operative duration (moderate evidence), however, is predictive of perioperative complications and a 2-stage surgery is related to an increased risk of major complications (high evidence). In terms of surgical techniques, higher rates of neck pain were found in patients undergoing laminoplasty compared with anterior spinal fusion (moderate evidence). In addition, with respect to laminoplasty techniques, there was a lower incidence of C-5 palsy in laminoplasty with concurrent foraminotomy compared with nonforaminotomy (low evidence). CONCLUSIONS The current review suggests that older patients are at a higher risk of perioperative complications. A longer operative duration and a 2-stage surgery both reflect increased case complexity and can indirectly predict perioperative complications.

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Can Prophylactic Bilateral C4/C5 Foraminotomy Prevent Postoperative C5 Palsy After Open-Door Laminoplasty?

Cited by 97 publications

References 19 publications

Effect of machined interfacet allograft spacers on cervical foraminal height and area

Effect of machined interfacet allograft spacers on cervical foraminal height and area

C5 nerve root palsy after posterior cervical spine surgery

A systematic review of clinical and surgical predictors of complications following surgery for degenerative cervical myelopathy

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