Delayed postoperative C5 root palsy and the use of neurophysiologic monitoring

Spitz, Steven; Felbaum, Daniel R.; Aghdam, Nima; Sandhu, Faheem A.

doi:10.1007/s00586-015-4252-z

Cited by 20 publications

(12 citation statements)

References 17 publications

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“…Yet, differentiation between these two possibilities could not be made. It has been also known that monitoring MEPs from deltoid muscle could fail to detect radicular lesion of C5 root and consecutively paresis of deltoid muscle (Spitz et al, 2015, Yanase et al, 2010). Furthermore, disappearance of MEPs in deltoid muscle is not always correlated with clinical outcome (Clark et al, 2013).…”

Section: Discussionmentioning

confidence: 99%

Corticobulbar motor evoked potentials from tongue muscles used as a control in cervical spinal surgery

Kim

Youn

et al. 2017

Clinical Neurophysiology Practice

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Section: Discussionmentioning

confidence: 99%

Corticobulbar motor evoked potentials from tongue muscles used as a control in cervical spinal surgery

Kim

Youn

et al. 2017

Clinical Neurophysiology Practice

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“…Peroperative neurophysiologic monitoring seemed of little value, electromyogram and somatosensory evoked potentials not being sensitive enough and having no predictive value. 14 Rowland et al 15 confirmed…”

Section: Does C5 Nerve Root Palsy Occur?mentioning

confidence: 94%

Laminoplasty for Cervical Spondylotic Myelopathy

Fransen¹

2014

The Journal of Spinal Surgery

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Cervical spondylotic myelopathy (CSM) is a commonly treated either by uninstrumented laminectomy, carrying the risk of postoperative instability, or by anterior or posterior decompression with fusion resulting in postoperative stiffness and possibly adjacent segment degeneration.Cervical laminoplasty, initially developed for pediatric or OPLL patients could be an interesting surgical alternative to decompress and reconstruct cervical anatomy without fusion.Sixteen patients, mean age 63, who presented with CSM were treated surgically using multilevel laminoplasty, and reviewed after 1 month, 6 months, 1 and 2 years. Clinical evaluation was performed based on the Benzel-JOA and Nurick scores. The preoperative mean Benzel-JOA score was 13.43; preoperative mean Nurick score was 1.81. Intramedullary hyperintensity in T2 MRI was observed in five patients. The operation was performed on 2 levels (19%) 3 levels (69%) and 4 levels (12%).We used the open-door hinged laminoplasty technique, using metallic implants, without bone graft. At one month FU, mean JOA score was 15.44, and Nurick dropped to 1.05. At 6 months, mean JOA was 16.36 and Nurick was 0.72. At one year, the mean JOA score was 16.16, and Nurick was 0.83. At 2 years, mean JOA was 17.5 and Nurick was 0.25.We reviewed the possible advantages and complications of spinal cord decompression by open-door laminoplasty for CSM. We conclude that this technique allows significant clinical improvement observed progressively in the two years following surgery without increased rigidity or instability.

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“…A fisiopatologia da paralisia pós-operatória (PO) de C5 ainda não é bem compreendida. A migração posterior da medula espinhal cervical após descompressão é uma das principais hipóteses [1][2][3][4][5][6][7][8][9][10][11] . Esta hipótese foi sustentada pelos achados obtidos por Sounders et al, que obteve redução significativa de radiculopatia C5 -de 14,6 % para 2,5% -diminuindo a extensão da corpectomia central de 20 para 15 milímetros 2 .…”

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“…Pode haver dor residual em cerca de 20% dos casos 11 . A recuperação é espontânea, o que justifica o emprego de tratamento conservador [1][2][3][4][5][6][7][8][9][10][11] .…”

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Paralisia de C5 Pós-Descompressão Medular Cervical

Lubini¹,

Vial²,

Schuch³

et al. 2018

jbnc

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A paralisia de C5 é uma conhecida complicação de cirurgia de descompressão medular cervical devido à mielopatia espondilótica crônica, que pode ser definida como déficit motor do deltóide e/ou do bíceps braquial, déficit sensitivo no território de C5, ou aumento da dor no território de C5 comparado ao status pré-operatório. Apresentamos um relato de caso de um paciente com mielopatia espondilótica cervical que foi submetido à laminectomia dos níveis C4 a C6 e evoluiu com paralisia de C5, obtendo melhora muito significativa em aproximadamente um ano. A incidência de paralisia de C5 pós-operatória pode variar de 0 a 30%, conforme a literatura. A fisiopatologia da paralisia pós-operatória de C5 ainda não é bem compreendida. Os pacientes geralmente têm bom prognóstico. A recuperação é espontânea, o que justifica o emprego de tratamento conservador. Há estudos comparando diferentes técnicas empregadas para descompressão medular cervical quanto à recuperação neurológica e a ocorrência de paralisia pós-operatória de C5, bem como avaliando o valor preditivo de monitoração neurofisiológica.

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Delayed postoperative C5 root palsy and the use of neurophysiologic monitoring

Abstract: Patients undergoing cervical decompression remain at risk for C5 root palsy despite use of monitoring. Given that all patients experienced delayed onset of C5 palsy, MEP, SSEP, and EMG may not be sensitive enough to assess the risk of developing C5 palsy.

Cited by 20 publications

References 17 publications

Corticobulbar motor evoked potentials from tongue muscles used as a control in cervical spinal surgery

Corticobulbar motor evoked potentials from tongue muscles used as a control in cervical spinal surgery

Laminoplasty for Cervical Spondylotic Myelopathy

Paralisia de C5 Pós-Descompressão Medular Cervical

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