Delayed C5 Palsy After Anterior Cervical Decompression Surgery: Preoperative Foraminal Stenosis and Postoperative Spinal Cord Shift Increase the Risk of Palsy

Takase, Hajime; Murata, Hidetoshi; Sato, Mitsuru; Tanaka, Takahiro; Miyazaki, Ryohei; Yoshizumi, Tetsuya; Tateishi, Kensuke; Kawahara, Nobutaka; Yamamoto, Tetsuya

doi:10.1016/j.wneu.2018.08.240

Cited by 17 publications

(21 citation statements)

References 41 publications

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“…A previous study showed that sufficient foraminotomy close to the vertebral artery has been found to be effective for avoiding C5 palsy. 12 This study has certain limitations, including its retrospective, single-center design, small number of patients, inclusion of patients with different diseases (CSM and OPLL), and no comparison between ACCF and multiple ACDF. Despite these limitations, we believe that our findings are of important as guidance for prevention of C5 palsy after ADF.…”

Section: Discussionmentioning

confidence: 97%

“…3,[12][13][14] Older patients are more at risk for C5 palsy, which may be because of the correlation of age with the number of surgical levels, reduced foraminal width, and the anterior shift of the spinal cord after ADF. 12 A metaanalysis found a significantly higher estimated prevalence of C5 palsy in males than in females, 14 and the incidence may also be higher in patients with OPLL than in those with CSM. 3,[15][16][17] In cases with massive OPLL, wide decompression may result in C5 palsy.…”

Section: Discussionmentioning

confidence: 99%

“…A relationship of C5 palsy with preexisting C4-C5 foraminal stenosis has also been proposed. 12,21 One study found a higher risk for C5 palsy when the C4-C5 foraminal diameter was < 2.7 mm and the correction angle exceeded 20 degrees in posterior instrumentation surgery. 24 In the current study, there was also a significant difference in the C5 intervertebral foramen width between patients with (1.9 mm) and without (3.1 mm) C5 palsy, but this was not essential for C5 palsy since many patients without C5 palsy had a narrow C5 intervertebral foramen.…”

Section: Discussionmentioning

confidence: 99%

“…Sex, age, and diagnosis have been proposed to have a significant influence on development of postoperative C5 palsy 3,12–14. Older patients are more at risk for C5 palsy, which may be because of the correlation of age with the number of surgical levels, reduced foraminal width, and the anterior shift of the spinal cord after ADF 12.…”

Section: Discussionmentioning

confidence: 99%

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

Nakajima

Honjoh²,

Watanabe³

et al. 2021

Clinical Spine Surgery: A Spine Publication

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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.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

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

Nakajima

Honjoh²,

Watanabe³

et al. 2021

Clinical Spine Surgery: A Spine Publication

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“…C5 nerve palsy is one of the most common complications after posterior cervical surgery [21]. The intervertebral foramen tends to be narrower at C4 and C5 while the ossi ed posterior longitudinal ligament is often the thickest at the C5 segment [22].…”

Section: Discussionmentioning

confidence: 99%

One-stage posterior laminectomy with instrumented fusion and foraminotomy for cervical ossification of posterior longitudinal ligament with radiculopathy pain

Shen

Luo

et al. 2021

Preprint

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ObjectiveTo explore the clinical efficacy of posterior LFF for cervical OPLL with radicular pain of upper limbs.MethodsBetween January 2014 and January 2018, 48 OPLL patients with radicular pain symptoms of upper limbs who underwent a one-stage posterior laminectomy and instrumented fusion with/without foraminotomy were reviewed retrospectively and divided into two groups: LF Group (laminectomy with instrumented fusion without foraminotomy) and LFF Group (laminectomy with instrumented fusion and foraminotomy). ໿Clinical data were assessed and compared between the two groups. The radicular pain of upper limbs and neck was measured using the visual analog scale (VAS). The neurological function was evaluated with the American Spinal Injury Association (ASIA) scale. Achievement of fusion and changes of sagittal alignment were investigated by postoperative plain x-ray or computed tomography (CT). Moreover, the decompression of spinal cord was evaluated based on postoperative MRI.ResultsAll the 48 patients were followed up for 24-42months with an average follow-up time of 31.1 ± 5.3 months. A total of 56 cervical intervertebral foramens were enlarged in 48 patients, including 40 case (83.3%) with 1 intervertebral foramens enlargement and 8 cases (16.7%) with 2 intervertebral foramen enlargements. There were no significant differences in intraoperative blood loss, ໿postoperative drainage amount, Japanese Orthopaedic Association (JOA) scores, JOA recovery rates, VAS scores for neck pain and ASIA grade between two groups. The mean operative time was shorter in the LF group compared with the LFF group. The ໿VAS score for arm pain was significantly lower while the surgical duration was longer in group B. No statistical difference was observed between the two group in terms of C2–C7 SVA, cervical lordosis, ໿focal angulation at the foraminotomy segment and local spinal cord angle. Compared with the LF group, there was no segmental kyphosis or instability where the additional posterior foraminotomy was performed in the LFF group.ConclusionsOne-stage posterior LFF can achieve satisfied clinical efficacy in improving neurological function and relieving the radicular pain of the upper limbs for OPLL patients with radiculopathy symptoms.

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Analysis of the spinal cord angle for severe cervical ossification of the posterior longitudinal ligament: comparison between anterior controllable antedisplacement and fusion (ACAF) and posterior laminectomy

et al. 2019

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Delayed C5 Palsy After Anterior Cervical Decompression Surgery: Preoperative Foraminal Stenosis and Postoperative Spinal Cord Shift Increase the Risk of Palsy

Cited by 17 publications

References 41 publications

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

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

One-stage posterior laminectomy with instrumented fusion and foraminotomy for cervical ossification of posterior longitudinal ligament with radiculopathy pain

Analysis of the spinal cord angle for severe cervical ossification of the posterior longitudinal ligament: comparison between anterior controllable antedisplacement and fusion (ACAF) and posterior laminectomy

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