Nerve root distribution of deltoid and biceps brachii muscle in cervical spondylotic myelopathy: a potential risk factor for postoperative shoulder muscle weakness after posterior decompression

Yonemura, Hiroshi; Taguchi, Toshihiko; Fujimoto, Hideaki; Toyoda, Kouichiro; Kawai, Shinya

doi:10.1007/s00776-004-0832-1

Cited by 11 publications

(5 citation statements)

References 7 publications

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“…Similar to our studies in rats ( 24 ), we predicted that lateral stimulation of the spinal cord would be more effective than midline stimulation. The strongest responses would be observed at the segment of innervation [e.g., C5 and C6 for biceps ( 36 ) and C7 for triceps] with spread from there to adjacent segments. Taken together, we expected that there would be a larger change in the size of motor evoked potentials when comparing midline to lateral stimulation within each segment than when comparing rostral-caudal cervical segments.…”

Section: Introductionmentioning

confidence: 99%

Intraoperative electrical stimulation of the human dorsal spinal cord reveals a map of arm and hand muscle responses

McIntosh

Joiner

Goldberg

et al. 2023

Journal of Neurophysiology

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While epidural stimulation of the lumbar spinal cord has emerged as a powerful modality for recovery of movement, how it should be targeted to the cervical spinal cord to activate arm and hand muscles is not well-understood, particularly in humans. We sought to map muscle responses to posterior epidural cervical spinal cord stimulation in humans. We hypothesized that lateral stimulation over the dorsal root entry zone would be most effective, and responses would be strongest in the muscles innervated by the stimulated segment. Twenty-five people undergoing clinically indicated cervical spine surgery were consented to map motor responses. During surgery, stimulation was performed in midline and lateral positions at multiple exposed segments; six arm and three leg muscles were recorded on each side of the body. Across all segments and muscles tested, lateral stimulation produced stronger muscle responses than midline despite similar latency and shape of responses. Muscles innervated at a cervical segment had the largest responses from stimulation at that segment, but responses were also observed in muscles innervated at other cervical segments and in leg muscles. The cervical responses were clustered in rostral (C4-C6) and caudal (C7-T1) cervical segments. Strong responses to lateral stimulation are likely due to the proximity of stimulation to afferent axons. Small changes in response sizes to stimulation of adjacent cervical segments argues for local circuit integration, and distant muscle responses suggest activation of long propriospinal connections. This map can help guide cervical stimulation to improve arm and hand function.

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Section: Introductionmentioning

confidence: 99%

Intraoperative electrical stimulation of the human dorsal spinal cord reveals a map of arm and hand muscle responses

McIntosh

Joiner

Goldberg

et al. 2023

Journal of Neurophysiology

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“… 1 – 16 It is defined as the new onset of deltoid muscle paralysis after a neuro-decompression procedure. 3 , 17 – 20 The incidence of C5 palsy reported after laminoplasty without concomitant nerve root decompression ranges from 5% to 17% 1 , 2 , 6 , 11 , 21 – 23 with 92% of the C5 palsy occurring unilaterally. 3 Majority of the motor symptoms occur within the first week after the operation 1 , 3 , 8 , 11 , 12 , 24 and are expected to resolve by 12 months.…”

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confidence: 99%

Why Does C5 Palsy Occur After Prophylactic Bilateral C4-5 Foraminotomy in Open-Door Cervical Laminoplasty? A Risk Factor Analysis

Liu

Reyes

Riew

2017

Global Spine Journal

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Study Design:Retrospective study.Objectives:To evaluate the efficacy of bilateral C4-5 foraminotomy in preventing occurrence of postoperative C5 palsy and to identify possible risk factors for its development.Methods:A total of 70 consecutive patients who underwent open-door laminoplasty with bilateral C4-5 foraminotomy were included. Clinical, radiographic, and operative data was reviewed. Development of postoperative C5 palsy was analyzed.Results:A total of 54 males and 16 females were reviewed. Mean age was 56 years (range, 30-86 years). The primary pathology was spondylosis in 76% of cases and ossified posterior longitudinal ligament in 21%. Radiographic evidence of C4-5 foraminal stenosis was seen in 81% of the patients. The mean duration of preoperative symptoms was 7 ± 19 months. Four (5.7%) out of 70 patients developed C5 palsy after open-door laminoplasty with bilateral C4-5 foraminotomy. Multivariate analysis showed that a long duration of preoperative symptoms (>12 months) and the presence of preoperative C4-5 T2-MRI cord signal change were statistically significant risk factors for the development of C5 palsy even after bilateral C4-5 foraminotomy in open-door laminoplasty (P < .0001 and P = .036, respectively).Conclusions:Prophylactic bilateral C4-5 foraminotomies do not completely eliminate the occurrence of C5 palsy. Prolonged duration of symptoms and presence of preoperative T2-MRI cord signal change increase the risk for developing postoperative C5 palsy despite foraminotomy.

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“…In patients with cervical myelopathy at the C4-5 level, the C5 nerve root was predominantly innervated for deltoid compared to those at other cervical intervertebral lesions, probably due to the segmental gray matter lesions of C6 spinal cord. 15 The weakness of shoulder abduction must be clinically apparent if postoperative C5 radiculopathy has occurred in patients whose C5 nerve root is predominantly innervated for deltoid muscles. Conversely, in the patients whose deltoid muscles are evenly innervated by C5 and C6 roots, postoperative shoulder muscle weakness is not apparent even if postoperative C5 radiculopathy occurs.…”

Section: Discussionmentioning

confidence: 99%

Investigation of Motor Dominant C5 Paralysis After Laminoplasty From the Results of Evoked Spinal Cord Responses

Kaneko

Hashiguchi

Kato

et al. 2006

Journal of Spinal Disorders &Amp; Techniques

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Cervical myelopathy at the C4-5 level is a potential risk for motor dominant C5 paralysis. Although it is merely a speculation, when C5 radiculopathy occurs after laminoplasty, C5 paralysis becomes clinically apparent because the deltoid muscle gets predominantly innervated by C5 root due to intramedullary spinal cord damage on the C6 segment in C4-5 myelopathy before surgery. It may represent the high signal intensity area on T2-weighted MRI at the C4-5 level.

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Nerve root distribution of deltoid and biceps brachii muscle in cervical spondylotic myelopathy: a potential risk factor for postoperative shoulder muscle weakness after posterior decompression

Cited by 11 publications

References 7 publications

Intraoperative electrical stimulation of the human dorsal spinal cord reveals a map of arm and hand muscle responses

Intraoperative electrical stimulation of the human dorsal spinal cord reveals a map of arm and hand muscle responses

Why Does C5 Palsy Occur After Prophylactic Bilateral C4-5 Foraminotomy in Open-Door Cervical Laminoplasty? A Risk Factor Analysis

Investigation of Motor Dominant C5 Paralysis After Laminoplasty From the Results of Evoked Spinal Cord Responses

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