Investigation of Segmental Motor Paralysis After Cervical Laminoplasty Using Intraoperative Spinal Cord Monitoring With Transcranial Electric Motor-evoked Potentials

Nakamae, Toshio; Tanaka, Nobuhiro; Nakanishi, Kazuyoshi; Kamei, Naosuke; Izumi, Bunichiro; Fujioka, Yuki; Ohta, Ryo; Ochi, Mitsuo

doi:10.1097/bsd.0b013e318211fc4e

Cited by 25 publications

(18 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Nassr et al [8] defined C5 palsy as loss of motor strength in the deltoid and/or biceps brachii, sensory deficit in the C5 distribution, or increased pain in the C5 distribution as compared with the preoperative status. Nakamae et al [16] defined C5 palsy as postoperative motor palsy of the deltoid and biceps muscles in the upper extremity by ≥1 grades in the manual muscle test (MMT) without sensory disturbance. These results highlight the need of a standard definition of C5 palsy in future studies.…”

Section: Discussionmentioning

confidence: 99%

Incidence and Risk Factors of C5 Palsy following Posterior Cervical Decompression: A Systematic Review

Cao

Gao

et al. 2014

PLoS ONE

View full text Add to dashboard Cite

BackgroundC5 palsy is a serious but poorly understood complication after posterior cervical decompression that could lead to muscle weakness, brachialgia and numbness of the upper limbs. The incidence of C5 palsy varies greatly between studies. The risk factors are inconclusive and even conflicting.ObjectTo perform a systematic review on the incidence and risk factors of C5 palsy after posterior cervical decompression.Materials and MethodsFour databases, PubMed, Embase, Web of Science and Cochrane CENTRAL, were searched to identify eligible studies. Either a fixed- or a random-effects model was used to calculate the pooled odd ratio (RR) or standardized mean difference (SMD) with its 95% confidence interval (95%CI).ResultsOf the 589 pre-recruited studies, 25 were included in this study for systematic review. The pooled incidence of C5 palsy after posterior decompression was 5.8% (95%CI: 4.4–7.2%). The incidence after open-door laminoplasty, double-door laminoplasty and laminectomy was 4.5%, 3.1% and 11.3%, respectively. The significant risk factors of C5 palsy were OPLL (OR, 2.188; 95%CI, 1.307–3.665), narrower intervertebral foramen (SMD, −0.972; 95%CI, −1.398 to −0.545), laminectomy (vs. open-door laminoplasty, OR, 2.988; 95%CI, 1.298–6.876), excessive spinal cord drift (SMD, 1.289, 95%CI, 0,197–2.381) and male gender (OR, 1.54; 95%CI, 1.036–2.301).ConclusionsThe results of this systematic review suggest that patients with excessive spinal cord drift, preexisting intervertebral foramenal stenosis, OPLL, laminectomy and male gender are at high risk for postoperative C5 palsy, and risk-reduction options should be considered for such patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Incidence and Risk Factors of C5 Palsy following Posterior Cervical Decompression: A Systematic Review

Cao

Gao

et al. 2014

PLoS ONE

View full text Add to dashboard Cite

show abstract

“…However, eight studies reported that patients diagnosed with OPLL had a higher tendency to develop C5 palsy than those with multilevel CDH or CSM. 3,6,16,21,24,[28][29][30] Therefore, the type of disease had a significant relationship with postoperative C5 palsy development.…”

Section: 5242627mentioning

confidence: 99%

“…Nassr et al determined that the incidence of C5 nerve palsy after cervical spine decompressive procedures was 6.7%, with an increased risk in male patients 22 ; Nakamae et al found that the incidence was 3.8% in males, which was significantly higher than the incidence in females of 1.9%. 16 The remaining five studies found no correlation between gender distribution of patients and C5 palsy after surgery.…”

Section: Risk Factorsmentioning

confidence: 99%

“…Most patients experienced palsy of the deltoid muscle in the early postoperative stage, with symptoms subsiding gradually. [15][16][17][18] However, a palsy with MMT 2 was sometimes irreversible, 19 and often decreased patients' quality of life and put a burden on their financial status by delaying their return to work after surgery. 18,20 The method employed to diagnose C5 palsy was the MMT, which divides the strength of the muscle into six grades from 0 to 5.…”

Section: Clinical Featuresmentioning

confidence: 99%

“…These five studies found that older age increased the risk of developing C5 palsy after posterior cervical surgery. 16,[20][21][22][23] However, another five studies found no relation between age and the development of C5 palsy after surgery. 2,5,[24][25][26] None of these studies further analyzed the relationship between this potential risk factor and C5 palsy development.…”

Section: Risk Factorsmentioning

confidence: 99%

See 2 more Smart Citations

C5 nerve root palsy after posterior cervical spine surgery

Fang

Wang

et al. 2017

J Orthop Surg (Hong Kong)

View full text Add to dashboard Cite

Background: C5 palsy is a serious complication after cervical decompression surgery in which the patient shows a deterioration in power of the deltoid or biceps brachii by at least one grade in the manual muscle test without aggravation of lower extremity function. Although there are several hypotheses regarding the etiology of C5 palsy, the pathogenesis and preventive measures remain unidentified and many other controversies remain. Objective: To systematically review the clinical features, risk factors, mechanism, and preventive measures of C5 palsy after posterior cervical decompression surgery. Materials and methods: PubMed was searched to identify eligible studies that contained more than 10 cases and focused on C5 palsy. Microsoft Excel was used to analyze the data. Statistical comparisons were made when appropriate. Results: Out of 718 papers involving C5 palsy, 28 met the inclusion criteria. The average incidence rate was 7.8% (range, 1.4-23.0%). Risk factors for C5 palsy included age, male gender, ossification of the posterior longitudinal ligament, and stenosis of the C4-C5 intervertebral foramen. C5 palsy occurred from immediately to 2 months after surgery, and recovery time ranged from 48 h to 41 months. Hypotheses for the mechanism of C5 palsy included root involvement and spinal cord impairment. Foraminotomy and intraoperative neuromonitoring were the two main methods used to prevent C5 palsy. Conclusion: C5 palsy is a serious complication occurring at the early stage after cervical decompression surgery. Foraminotomy and intraoperative neuromonitoring were the two main methods to prevent C5 palsy. The incidence of C5 palsy is low, but it can place a serious burden on the patients' quality of life and finances. The risk factors and mechanism of C5 palsy are still controversial. However, under conservative therapy, the prognosis is usually good. Higher quality studies are necessary for drawing more reliable and convincing conclusions about this disease.

show abstract

Prevalence of C5 nerve root palsy after cervical decompressive surgery: a meta-analysis

et al. 2015

View full text Add to dashboard Cite

show abstract

Investigation of Segmental Motor Paralysis After Cervical Laminoplasty Using Intraoperative Spinal Cord Monitoring With Transcranial Electric Motor-evoked Potentials

Cited by 25 publications

References 0 publications

Incidence and Risk Factors of C5 Palsy following Posterior Cervical Decompression: A Systematic Review

Incidence and Risk Factors of C5 Palsy following Posterior Cervical Decompression: A Systematic Review

C5 nerve root palsy after posterior cervical spine surgery

Prevalence of C5 nerve root palsy after cervical decompressive surgery: a meta-analysis

Contact Info

Product

Resources

About