Prophylaxis of C5 palsy after cervical expansive laminoplasty by bilateral partial foraminotomy

Komagata, Masashi; Nishiyama, Makoto; Endo, Kenji; Ikegami, Hitoshi; Tanaka, Satoshi; Imakiire, Atsuhiro

doi:10.1016/j.spinee.2004.03.022

Cited by 124 publications

(72 citation statements)

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“…Although there were many reports of good postoperative neurological improvements after laminoplasty for cervical myelopathy [12,23,28], several postoperative problems have also been reported, including late deterioration of myelopathy symptoms [9,15,20,23], C5 root palsies [3,16,17,21,28], axial symptoms [7,11,14,24,25,31], cervical malalignment [8,15,26,28,30] and loss of flexion-extension ROM [1,5,6,13,15,22,26,28,30]. Especially in recent years, a great deal of attention has been paid to axial symptoms as postoperative complications which adversely affect patients' quality of life.…”

Section: Discussionmentioning

confidence: 99%

Limitation of activities of daily living accompanying reduced neck mobility after laminoplasty preserving or reattaching the semispinalis cervicis into axis

et al. 2007

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Although difficulties with neck mobility often interfere with patients' activities of daily living (ADL) after cervical laminoplasty, there was no detailed study on the relation between the limitations of ADL accompanying postoperative reduced neck mobility and the cervical posterior approach. The aim of this study was to compare retrospectively the frequency of limitations of ADL accompanying neck mobility after laminoplasty preserving the semispinalis cervicis inserted into the C2 spinous process with that after laminoplasty reattaching the muscle to C2. Forty-nine patients after C4-C7 laminoplasty with C3 laminectomy preserving the semispinalis cervicis inserted into C2 (Group A) and 24 patients after C3-C7 laminoplasty reattaching the muscle (Group B) were evaluated. The frequency of postoperative limitations of ADL accompanying each of three neck movements of extension, flexion and rotation were investigated. The postoperative O-C7 angles at extension and flexion was measured on lateral extension and flexion radiographs of the cervical spine, respectively. The postoperative cervical range of motion in rotation was measured in the cranial view using a digital camera. Frequency of limitations of ADL accompanying extension was lower (P = 0.037) in Group A (2%) than in Group B (17%). Frequency of limitations of ADL accompanying flexion was similar in Group A (8%) and Group B (4%). Frequency of limitations of ADL accompanying rotation was lower (P = 0.031) in Group A (12%) than in Group B (33%). Average O-C7 angle at extension was significantly larger (P = 0.002) in Group A (147°) than in Group B (136°). Average O-C7 angle at flexion was similar in Group A (93°) and Group B (91°). Average range of motion in rotation was significantly larger (P = 0.004) in Group A (110°) than in Group B (91°). This retrospective study suggested that the frequency of limitations of ADL accompanying neck extension or rotation was lower after laminoplasty preserving the semispinalis cervicis inserted into C2 than after laminoplasty reattaching the muscle.

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Section: Discussionmentioning

confidence: 99%

Limitation of activities of daily living accompanying reduced neck mobility after laminoplasty preserving or reattaching the semispinalis cervicis into axis

et al. 2007

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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%

“…There was consensus in the literature that age (n = 4), 7,31,43,53 sex (n = 2), 7,31 preoperative severity (n = 5), 7,12,31,43,53 muscle manual test results (n = 2), 7,43 duration of symptoms (n = 2), 31,43 diagnosis (n = 2), 31,53 preoperative cervical lordosis (n = 2), 31,53 and cervical curvature (n = 2) 43,49 are not significant predictors of nerve root palsy. In a study by Imagama et al, patients experiencing C-5 palsy had a smaller C-5 intervertebral foramen width and a higher degree of anterior protrusion of the superior articular process of C-5.…”

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confidence: 99%

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

Tetreault

Ibrahim

Côté

et al. 2016

SPI

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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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“…Si el desplazamiento es de todo el cilindro dural, ¿por qué los sínto-mas son unilaterales? Quizás otros mecanismos como una lesión radicular 8 o una estenosis foraminal previas 9 , en un lado, podrían hacer más sensible a la raíz correspondiente TABLA 1 -Medición de las raíces cervicales en mm ante cualquier desplazamiento. Actualmente no se descarta totalmente que la lesión sea medular 10 .…”

Section: Discussionunclassified

Longitud de las raíces cervicales en resonancia magnética: relación con la parálisis postoperatoria de la quinta raíz cervical

Mezzadri

Rimoldi

2010

Coluna/Columna

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Prophylaxis of C5 palsy after cervical expansive laminoplasty by bilateral partial foraminotomy

Cited by 124 publications

References 1 publication

Limitation of activities of daily living accompanying reduced neck mobility after laminoplasty preserving or reattaching the semispinalis cervicis into axis

Limitation of activities of daily living accompanying reduced neck mobility after laminoplasty preserving or reattaching the semispinalis cervicis into axis

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

Longitud de las raíces cervicales en resonancia magnética: relación con la parálisis postoperatoria de la quinta raíz cervical

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