C5 nerve root palsy following decompression of cervical spine with anterior versus posterior types of procedures in patients with cervical myelopathy

Başaran, Recep; Kaner, Tuncay

doi:10.1007/s00586-016-4567-4

Cited by 25 publications

(18 citation statements)

References 66 publications

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“…In our patient cohort, C5 nerve root palsy rate for ACDF only was lowest with 1.13% which is consistent with the literature[ 23 ]. C5 palsy only occurred when segments C4/5 and/or C5/6 were involved in the procedure.…”

Section: Discussionsupporting

confidence: 92%

“…This observation is in line with the study groups of Bydon and Nassr et al ., who also describe an increasing incidence of C5 palsy after multilevel decompression procedures[ 21 , 22 ]. As the risk of developing a C5 nerve root palsy increased significantly with an increasing number of corpectomies, previous groups suggested the preferential application of a hybrid construct with corpectomy and ACDF whenever possible[ 23 – 25 ]. We now confirm these suggestions, as the overall incidence of C5 palsy in a combination of ACDF with one-level corpectomy was only 10.7% in our patients compared to 30.3% in two-level corpectomy.…”

Section: Discussionmentioning

confidence: 99%

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Impact of the surgical strategy on the incidence of C5 nerve root palsy in decompressive cervical surgery

et al. 2017

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ObjectiveOur aim was to identify the impact of different surgical strategies on the incidence of C5 palsy.BackgroundDegenerative cervical spinal stenosis is a steadily increasing morbidity in the ageing population. Postoperative C5 nerve root palsy is a common complication with severe impact on the patients´ quality of life.MethodsWe identified 1708 consecutive patients who underwent cervical decompression surgery due to degenerative changes. The incidence of C5 palsy and surgical parameters including type and level of surgery were recorded to identify predictors for C5 nerve palsy.ResultsThe overall C5 palsy rate was 4.8%, with 18.3% of cases being bilateral. For ACDF alone the palsy rate was low (1.13%), compared to 14.0% of C5 palsy rate after corpectomy. The risk increased with extension of the procedures. Hybrid constructs with corpectomy plus ACDF at C3-6 showed significantly lower rates of C5 palsy (10.7%) than corpectomy of two vertebrae (p = 0.005). Multiple regression analysis identified corpectomy of C4 or C5 as a significant predictor. We observed a lower overall incidence for ventral (4.3%) compared to dorsal (10.9%) approaches (p<0.001). When imaging detected a postoperative shift of the spinal cord at index segment C4/5, palsy rate increased significantly (33.3% vs. 12.5%, p = 0.034).ConclusionsExtended surgical strategies, such as dorsal laminectomies, multilevel corpectomies and procedures with extensive spinal cord shift were shown to display a high risk of C5 palsy. The use of extended procedures should therefore be employed cautiously. Switching to combined surgical methods like ACDF plus corpectomy can reduce the rate of C5 palsy.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Impact of the surgical strategy on the incidence of C5 nerve root palsy in decompressive cervical surgery

et al. 2017

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“…Previous reviews [ 2 , 8 , 15 ] on the prevalence and risk factors of C5 palsy have few included studies or some included studies in the 1990s and 2000s, which was far from now. So, we performed a meta-analysis on incidence of C5 palsy for the last decade.…”

Section: Introductionmentioning

confidence: 99%

Incidence of C5 nerve root palsy after cervical surgery

Wang

Liu

et al. 2017

Medicine

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Purpose:We aim to perform a meta-analysis on incidence of C5 nerve root palsy (C5 palsy) for patients after cervical surgery.Methods:An extensive search of the literature was performed in PubMed/MEDLINE, Embase, the Cochrane library, CNKI, and WANFANG databases on incidence of C5 palsy from January 2007 to January 2017. Prevalence of C5 palsy related to different surgery methods was calculated and data analysis was conducted with STATA 12.0.Results:A total of 61 studies containing 721 patients with C5 palsy in total 11,481 patients (6.3%) were included in our study. The incidences after anterior cervical discectomy and fusion (ACDF), anterior cervical corpectomy and fusion (ACCF), anterior corpectomy combined with discectomy (ACCDF), laminoplasty (LP) and laminectomy and fusion (LF) were 5.5%, 7.5%, 6%, 4.4%, and 12.2%, respectively. Compared with anterior approaches (5%), female patients (4%) and patients with cervical spondylotic myelopathy (CSM) (4.8%), posterior approaches (6.2%), male patients (5.7%) and patients with ossification of posterior longitudinal ligament (OPLL) (8.1%) have a higher prevalence. In ACDF and LP, patients with OPLL (5.5%, 8.1%, respectively) have a higher incidence than those in patients with CSM (4.7%, 3.1%, respectively); however, in LF, patients with CSM and OPLL have similar incidence of C5 palsy (13% vs 13.1%). In most cases, C5 palsy was unilateral (74.5%).Conclusions:Based on our meta-analysis, posterior approaches, male patients and patients with OPLL have a higher incidence of C5 palsy. In ACDF and LP, patients with OPLL have a higher incidence of C5 palsy, but in LF, patients with CSM and OPLL have similar result.

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“…Yang et al (9) confronted laminectomy group vs. laminoplasty group reporting a higher incidence in laminectomy group. On the other hand, Basaran et al (10), after a review of the literature, reported a higher incidence in laminoplasty compared to laminectomy, perhaps the highest incidence was found in laminectomy and fusion. The correction of cervical lordotic alignment with posterior instrumentation has been supposed as a contributing factor since able to induce iatrogenic foraminal stenosis and increase the spinal cord shift (11).…”

Section: Discussionmentioning

confidence: 99%

C5 palsy after insertion of a winged expandable cervical cage: a case report and literature review

et al. 2017

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C5 nerve root palsy is a well-known complication after anterior or posterior cervical decompression. Many theories have been proposed but the etiology is still unclear. The use of a winged expandable cage after single or multiple corpectomy is among the used techniques in reconstructing the cervical spine. Herein we report a case of C5 palsy after a three-level corpectomy and reconstruction using this device for the treatment of cervical spondylosis. In our case the preexisting foraminal stenosis, wide anterior decompression and partial improvement of cervical alignment were factors supposed contributing to the palsy.

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C5 nerve root palsy following decompression of cervical spine with anterior versus posterior types of procedures in patients with cervical myelopathy

Cited by 25 publications

References 66 publications

Impact of the surgical strategy on the incidence of C5 nerve root palsy in decompressive cervical surgery

Impact of the surgical strategy on the incidence of C5 nerve root palsy in decompressive cervical surgery

Incidence of C5 nerve root palsy after cervical surgery

C5 palsy after insertion of a winged expandable cervical cage: a case report and literature review

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