Clinical and Radiographic Analysis of C5 Palsy After Anterior Cervical Decompression and Fusion for Cervical Degenerative Disease

Kim, Sungjin; Lee, Sun-Ho; Kim, Eun-Sang; Eoh, Whan

doi:10.1097/bsd.0b013e31826a10b0

Cited by 51 publications

(46 citation statements)

References 24 publications

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“…In our series, we had one case (1.5%) with C5 root palsy which is lower than the incidence of Kim et al's [34] series which reported a rate of 4.3%. Incidence of graft extrusion has ranged between 0 and 0.88% [12, 26, 35].…”

Section: Discussioncontrasting

confidence: 59%

An Outcome Study of Anterior Cervical Discectomy and Fusion among Iranian Population

Haghnegahdar

Sedighi

2016

Neuroscience Journal

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Background and Aim. First-line treatment strategy for managing cervical disc herniation is conservative measures. In some cases, surgery is indicated either due to signs/symptoms of severe/progressive neurological deficits, or because of persistence of radicular pain despite 12 weeks of conservative treatment. Success for treatment of cervical disc herniation using ACDF has been successfully reported in the literature. We aim to determine the outcome of ACDF in treatment of cervical disc herniation among Iranians. Methods and Materials/Patients. In a retrospective cohort study, we evaluated 68 patients who had undergone ACDF for cervical disc herniation from March 2006 to March 2011. Outcome tools were as follows: (1) study-designed questionnaire that addressed residual and/or new complaints and subjective satisfaction with the operation; (2) recent (one week prior to the interview) postoperative VAS for neck and upper extremity radicular pain; (3) Japanese Orthopaedic Association Myelopathy Evaluation Questionnaire (JOACMEQ) (standard Persian version); and (4) follow-up cervical Magnetic Resonance Imaging (MRI) and lateral X-ray. Results. With mean follow-up time of 52.93 (months) ± 31.89 SD (range: 13–131 months), we had success rates with regard to ΔVAS for neck and radicular pain of 88.2% and 89.7%, respectively. Except QOL functional score of JOAMEQ, 100% success rate for the other 4 functional scores of JOAMEQ was achieved. Conclusion. ACDF is a successful surgical technique for the management of cervical disc herniation among Iranian population.

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Section: Discussioncontrasting

confidence: 59%

An Outcome Study of Anterior Cervical Discectomy and Fusion among Iranian Population

Haghnegahdar

Sedighi

2016

Neuroscience Journal

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“…Fifty-seven studies [20–28,30,33–35,37–39,42–43,45,47–48,50,52–56,59,61–71,73–75,77–79,82–85,88,89,91–96] containing 355 patients with C5 plasy of 6349 patients after cervical surgery were included. Figure 3 shows that the incidence was 5.3% (95% CI 4.3%–6.2%), with substantial heterogeneity of incidence observed.…”

Section: Resultsmentioning

confidence: 99%

Prevalence of complications after surgery in treatment for cervical compressive myelopathy

et al. 2017

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Purpose:We aim to perform a meta-analysis on prevalence of all kinds of operation-related complications following surgery treating cervical compressive myelopathy (CCM) and to provide reference for surgeons making surgical plan.Methods:An extensive search of literature was performed in PubMed/MEDLINE, Embase, the Cochrane library, CNKI, and WANFANG databases on incidence of operation-related complications from January 2007 to November 2016. Data was calculated and data analysis was conducted with STATA 12.0 and Revman 5.3.Results:A total of 107 studies included 1705 of 8612 patients (20.1%, 95% CI 17.3%–22.8%) on overall complications. The incidence of C5 plasy, cerebrospinal fluid (CSF), infection, axial pain, dysphagia, hoarseness, fusion failure, graft subsidence, graft dislodgment, and epidural hematoma is 5.3% (95% CI 4.3%–6.2%), 1.9% (95% CI 1.3%–2.4%), 2.8% (95% CI 1.7%–4.0%), 15.6% (95% CI 11.7%–19.5%), 16.8% (95% CI 13.6%–19.9%), 4.0% (95% CI 2.3%–5.7%), 2.6% (95% CI 0.2%–4.9%), 3.7% (95% CI 2.0%–5.5%), 3.4% (95% CI 2.0%–4.8%), 1.1% (95% CI 0.7%–1.5%), respectively. Patients with ossification of posterior longitudinal ligament (OPLL) (6.3%) had a higher prevalence of C5 plasy than those with cervical spondylotic myelopathy (CSM) (4.1%), and a similar trend in CSF (12.2% vs 0.9%). Individuals after laminectomy and fusion (LF) had highest rate of C5 plasy (15.2%), while those who underwent anterior cervical discectomy and fusion (ACDF) had the lowest prevalence (2.0%). Compared with patients after other surgical options, individuals after anterior cervical corpectomy and fusion (ACCF) have the highest rate of CSF (4.2%), infection (14.2%), and epidural hematoma (3.1%). Patients after ACDF (4.8%) had a higher prevalence of hoarseness than those with ACCF (3.0%), and a similar trend for dysphagia between anterior corpectomy combined with discectomy (ACCDF) and ACCF (16.8% vs 9.9%).Conclusions:Based on our meta-analysis, patients with OPLL have a higher incidence of C5 palsy and CSF. Patients after LF have a higher incidence of C5 palsy, ACCDF have a higher incidence of dysphagia, ACCF have a higher incidence of CSF and infection and ACDF have a higher incidence of hoarseness. These figures may be useful in the estimation of the probability of complications following cervical surgery.

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“…22 C5 palsy has been reported mainly after posterior cervical surgery, but can also be seen after surgery using the anterior approach. Kim et al reported that 6 of 134 patients suffered from C5 palsy after anterior cervical discectomy fusion, and 2 patients with C5 palsy had significant weakness of the deltoid muscle (MMT grade 1) 11 ; the authors conducted foraminotomy on these two patients and only one showed full recovery. Hashimoto et al also reported that 17 of 199 patients who underwent anterior decompression surgery and spinal fusion suffered from C5 palsy.…”

Section: Journal Of Orthopaedic Surgery 25(1)mentioning

confidence: 99%

“…Such a complication has been reported mainly after posterior cervical surgery, but has also been documented after surgery via the anterior approach. 11,12 Although many studies on C5 palsy after posterior cervical surgery have been published, the results are often inconclusive and even conflicting. 13,14 Here, we provide a systematic review of the current literature and attempt to analyze the conflicting results among studies to better understand the clinical features, influencing factors, and preventive measures of C5 palsy after posterior cervical surgery.…”

Section: Introductionmentioning

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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Clinical and Radiographic Analysis of C5 Palsy After Anterior Cervical Decompression and Fusion for Cervical Degenerative Disease

Cited by 51 publications

References 24 publications

An Outcome Study of Anterior Cervical Discectomy and Fusion among Iranian Population

An Outcome Study of Anterior Cervical Discectomy and Fusion among Iranian Population

Prevalence of complications after surgery in treatment for cervical compressive myelopathy

C5 nerve root palsy after posterior cervical spine surgery

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