Prospective Study and Multivariate Analysis of the Incidence of C5 Palsy After Cervical Laminoplasty

Abstract

This study showed significant evidence indicating the higher risk of postoperative C5 palsy in open-door LP than double-door LP. Because OPLL as well as open-door LP were recognized as the risk factors of C5 palsy, asymmetric decompression by open-door LP might introduce imbalanced rotational movement of spinal cord and result in C5 palsy. We recommend double-door LP to minimize the postoperative C5 palsy, in particularly, if the patient has OPLL.

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

“…The degree of PPDCP and PADCP was graded in our study using the manual muscle test (graded from 0 to 5, with 0 as no movement and power and 5 with normal strength). The PPDCP in five of the studied cases was grade 0 (2 immediately and 3 over one week period), 3 were grade 1 and 2 were grade 2. cervical decompression for CSM has been reported to average 4.6% (range 0%-30%) [7][8][9]11,13,14]. The incidence of C5 palsy in this study is comparable at 20%.…”

“…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.…”

“…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].…”

Cervical Spondylotic Myelopathy: Pathophysiology, Clinical Presentation, and Treatment

“…Risks unique to laminaplasty include premature lamina closure after open-door technique with resultant re-stenosis [33] and axial neck pain [40]. Cervical nerve root palsy (most commonly C5 palsy) remains a risk predominantly of posterior cervical decompression [29] but has also been reported to occur following anterior decompression [22].…”

Alterations in axial curvature of the cervical spine with a combination of rotation and extension in the conventional anterior cervical approach

“…Kaneyama et al [18] reported that asymmetric decompression by open-door laminoplasty may introduce imbalanced rotational movement of the spinal cord and result in C5 palsy. In this study, simulated corpectomy using axial scanned images in the ER-position showed that the width of corpectomy was directed to the right.…”