Contribution of Lordotic Correction on C5 Palsy Following Cervical Laminectomy and Fusion

Cherian, Jacob; Mayer, Rory R.; Haroun, Kareem B.; Winnegan, Lona; Omeis, Ibrahim

doi:10.1227/neu.0000000000001199

Cited by 17 publications

(7 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…To our knowledge, only one study examined the incidence of C5 palsy with laminectomy and fusion using LMS in association with posterior foraminotomy [ 42 ]. In that study, the C5 palsy incidence was higher (14.1%) [ 42 ] and similar to the rates previously reported for non-foraminotomy fusion procedures [ 3 , 6 ]. This may have been due to insufficient foraminotomy to preserve sufficient bone for LMS.…”

Section: Discussionsupporting

confidence: 88%

“…Collectively, foramen decompression by either uncovertebrectomy or foraminotomy resulted in substantially lower C5 palsy rates (10.1% in group 1, 4.2% in group 2, and 0% in group 3) than previously reported in laminectomy fusion studies. In the meta-analysis by Wang et al, the incidence after posterior fusion was 12.2% overall, including 13.3% in patients with cervical spondylotic myelopathy and 13.1% in those with the ossification of the posterior longitudinal ligament [ 6 , 43 ]. The incidence of C5 palsy was even higher in some studies: 28.9% after posterior laminectomy and fusion in the study reported by Blizzard et al [ 3 , 44 ] and 36.4% after combination surgery in the study by Chang et al [ 45 ].…”

Section: Discussionmentioning

confidence: 99%

“…Cervical myeloradiculopathy is the most frequent cause of spinal cord impairment in the elderly population [ 1 , 2 ], leading to an increase in the frequency of cervical decompressive surgery. Postoperative C5 palsy represents one of the commonest complications, occurring in up to 28.9%, mainly with fusion surgeries [ 3 , 4 , 5 , 6 ], and is almost always associated with severe morbidity and reduced quality of life [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Posterior Preventive Foraminotomy before Laminectomy Combined with Pedicle Screw Fixation May Decrease the Incidence of C5 Palsy in Complex Cervical Spine Surgery in Patients with Severe Myeloradiculopathy

Lee

Abdou

Kwon

et al. 2023

JCM

View full text Add to dashboard Cite

C5 palsy is a frequent sequela of cervical decompression surgeries for cervical myeloradiculopathy. Although many researchers have suggested various risk factors, such as cord shifting and the correction of lordotic angles, the tethering of the C5 root beneath the narrow foramen is an independent risk factor for C5 palsy. In this study, we tried to investigate different techniques for foramen decompression with posterior cervical fusion and assess the incidence of C5 palsy with each technique depending on the order of foraminal decompression. A combined 540° approach with LMS and uncovertebrectomy was used in group 1. Group 2 combined a 540° approach with pedicle screws and posterior foraminotomy, while posterior approach only with pedicle screws and foraminotomy was used in group 3. For groups 2 and 3, prophylactic posterior foraminotomy was performed before laminectomy. Motor manual testing to assess C5 palsy, the Neck Disability Index (NDI) and the Japanese Orthopedic Association (JOA) scores were determined before and after surgery. Simple radiographs, MRI and CT scans, were obtained to assess radiologic parameters preoperatively and postoperatively. A total of 362 patients were enrolled in this study: 208 in group 1, 72 in group 2, and 82 in group 3. The mean age was 63.2, 65.5, and 66.6 years in groups 1, 2, and 3, respectively. The median for fused levels was 4 for the three groups. There was no significant difference between groups regarding the number of fused levels. Weight, height, comorbidities, and diagnosis were not significantly different between groups. Preoperative JOA scores were similar between groups (p = 0.256), whereas the preoperative NDI score was significantly higher in group 3 than in group 2 (p = 0.040). Mean JOA score at 12-month follow-up was 15.5 ± 1.89, 16.1 ± 1.48, and 16.1 ± 1.48 for groups 1, 2, and 3, respectively; it was higher in group 3 compared with group 1 (p = 0.008) and in group 2 compared with group 1 (p = 0.024). NDI score at 12 months was 13, 12, and 13 in groups 1, 2, and 3, respectively; it was significantly better in group 3 than in group 1 (p = 0.040), but there were no other significant differences between groups. The incidence of C5 palsy was significantly lower in posterior foraminotomy groups with pedicle screws (groups 2 and 3) than in LMS with uncovertebrectomy (group 1) (p < 0.001). Thus, preventive expansive foraminotomy before decompressive laminectomy is able to significantly decrease the root tethering by stenotic lesion, and subsequently, decrease the incidence of C5 palsy associated with posterior only or combined posterior and anterior cervical fusion surgeries. Additionally, such expansive foraminotomy might be appropriate with pedicle screw insertion based on biomechanical considerations.

show abstract

Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Posterior Preventive Foraminotomy before Laminectomy Combined with Pedicle Screw Fixation May Decrease the Incidence of C5 Palsy in Complex Cervical Spine Surgery in Patients with Severe Myeloradiculopathy

Lee

Abdou

Kwon

et al. 2023

JCM

View full text Add to dashboard Cite

show abstract

“…Some experts and scholars found that once cervical kyphosis was corrected, the incidence of C5 palsy obviously increased. [14–16] Because the cervical sagittal sequence is restored to lordosis, the spinal cord is more likely to “drift backward” under the action of the bowstring principle, thereby significantly increasing nerve root tension. However, the backward shift distance of the spinal cord located atop the bowstring is at the maximum, which would over-retract the C5 nerve root, leading to the occurrence of the nerve root palsy phenomenon under the effect of ischemia and anoxia of the nerve root, segmental spinal cord obstacles, embolism, and reperfusion injury, among other factors.…”

Section: Discussionmentioning

confidence: 99%

Limited laminectomy and foraminal decompression combined with internal fixation for treating multi-segment cervical spondylotic myelopathy

Zhao

Cheng²,

Chen³

et al. 2018

Medicine

View full text Add to dashboard Cite

Laminectomy is an effective surgical treatment for multi-segment cervical spondylotic myelopathy (M-CSM) but usually results in C5 palsy. Some surgical techniques to restore the spinal sequence, increase the intervertebral foramen diameter, and limit the spinal cord drift distance have been proposed; however, it is unclear whether these procedures can avoid this complication. To investigate the clinical efficacy of limited laminectomy and foraminal decompression with fixation (LLFDF) for improving neurological recovery and preventing C5 palsy. A total of 71 patients with M-CSM were retrospectively analyzed. Thirty-nine of them were treated with LLFDF (group A) and 32 with normal laminectomy with fixation (NLF; group B) after 3 months of formal conservative treatment. Pre- and postoperative neurological function, spinal cord drift distance, cervical curvature index (CCI), and number of C5 palsy cases were recorded and analyzed. There was no significant intergroup difference in the surgical time or intraoperative blood loss ( P >.05). The laminectomy widths in groups A and B were 16.7 ± 2.6 mm and 21.8 ± 2.9 mm, respectively ( P <.01), while the spinal cord drift distances were 2.3 ± 0.4 mm and 3.6 ± 0.7 mm, respectively ( P <.01). The mean Japanese Orthopedic Association score of both groups increased significantly after surgery ( P <.01), and no significant difference was noted at any observation time points ( P >.05). Both groups demonstrated significant CCI improvements after surgery compared with those before surgery ( P <.01). There were 2 cases of C5 palsy in group A (5.1%) and 8 cases in group B (25.0%), and the difference was significant ( P <.05). LLFDF can relieve spinal compression and considerably promote neurological recovery. Moreover, it restricts excessive spinal cord back drifting and decreases the incidence of C5 palsy.

show abstract

“…50 C5 radiculopathy and other cervical nerve root palsies are another poorly misunderstood phenomenon with controversial etiology. 51 Despite an unclear cause, there are several measures that should be taken to try to avoid this potentially debilitating injury. During positioning, avoid excessive downward traction on the shoulders with taping.…”

Section: Complicationsmentioning

confidence: 99%

Anterior Reconstruction Techniques for Cervical Spine Deformity

et al. 2020

View full text Add to dashboard Cite

Cervical spine deformity is an uncommon yet severely debilitating condition marked by its heterogeneity. Anterior reconstruction techniques represent a familiar approach with a range of invasiveness and correction potential-including global or focal realignment in the sagittal and coronal planes. Meticulous preoperative planning is required to improve or prevent neurologic deterioration and obtain satisfactory global spinal harmony. The ability to perform anterior only reconstruction requires mobility of the opposite column to achieve correction, unless a combined approach is planned. Anterior cervical discectomy and fusion has limited focal correction, but when applied over multiple levels there is a cumulative effect with a correction of approximately 6° per level. Partial or complete corpectomy has the ability to correct sagittal deformity as well as decompress the spinal canal when there is anterior compression behind the vertebral body. If pathoanatomy permits, a hybrid discectomy-corpectomy construct is favored over multilevel corpectomies. The anterior cervical osteotomy with bilateral complete uncinectomy may be necessary for angular correction of fixed cervical kyphosis, and is particularly useful in the midcervical spine. A detailed understanding of the patient's local anatomy, careful attention to positioning, and avoiding long periods of retraction time will help prevent complications and iatrogenic injury.

show abstract

Contribution of Lordotic Correction on C5 Palsy Following Cervical Laminectomy and Fusion

Abstract: CLF, cervical laminectomy and fusion.

Cited by 17 publications

References 20 publications

Posterior Preventive Foraminotomy before Laminectomy Combined with Pedicle Screw Fixation May Decrease the Incidence of C5 Palsy in Complex Cervical Spine Surgery in Patients with Severe Myeloradiculopathy

Posterior Preventive Foraminotomy before Laminectomy Combined with Pedicle Screw Fixation May Decrease the Incidence of C5 Palsy in Complex Cervical Spine Surgery in Patients with Severe Myeloradiculopathy

Limited laminectomy and foraminal decompression combined with internal fixation for treating multi-segment cervical spondylotic myelopathy

Anterior Reconstruction Techniques for Cervical Spine Deformity

Contact Info

Product

Resources

About