Preoperative electrophysiologic assessment of C5-innervated muscles in predicting C5 palsy after posterior cervical decompression

Zheng, Chaojun; Nie, Cong; Zhu, Yu; Xu, Min; Lyu, Feizhou; Jiang, Jianyuan; Xia, Xinlei

doi:10.1007/s00586-021-06757-9

Cited by 6 publications

(9 citation statements)

References 22 publications

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“…We set the follow-up period based on our hypothesis that ePNS could predict early postoperative outcomes, based on previous studies showing that the effect of ePNS lasts 30 to 60 minutes. [17][18][19][20][21][22] Although our original hypothesis was substantiated by this study, we believe that it is necessary to investigate whether longerterm results can also be informed by this testing modality. Second, our sample size was small as this was a singlecenter proof of concept study.…”

Section: Discussionmentioning

confidence: 72%

“…In this study, we tested the hypothesis that the immediate and short-term effects of ePNS on the performance of 10-second test could predict functional outcomes after laminoplasty for CSM. The background for this hypothesis is a previous study showing that the pathogenesis of CSM in patients with early postoperative recovery may be reversible spinal cord ischemia due to spinal cord compression, and ePNS has been shown to increase blood flow in the spinal cord in situations where such blood supply remains viable 6–14,17–22. We conducted a 10-second test before and after preoperative ePNS, and postoperatively at discharge (one week after surgery) in 44 patients with CSM who underwent C3-C7 laminoplasty and evaluated their correlations.…”

Section: Discussionmentioning

confidence: 99%

“…Electrical peripheral nerve stimulation (ePNS) has been applied to treat intractable pain caused by CSM, movement disorders caused by cervical spinal cord injury, and intermittent claudication caused by lumbar spinal stenosis 15–17. Electrical stimulation of peripheral nerves has been shown to temporarily increase blood flow within the spinal cord (30 min to 1 h) 17–22. Thus, we speculated that ePNS could indicate the presence of reversible spinal cord ischemia due to spinal cord compression.…”

mentioning

confidence: 99%

“…[15][16][17] Electrical stimulation of peripheral nerves has been shown to temporarily increase blood flow within the spinal cord (30 min to 1 h). [17][18][19][20][21][22] Thus, we speculated that ePNS could indicate the presence of reversible spinal cord ischemia due to spinal cord compression. We hypothesized that the immediate and short-term effects of ePNS on performance of the 10-second test could predict the early postoperative outcomes of patients with CSM.…”

mentioning

confidence: 99%

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Using Electrical Stimulation of the Ulnar Nerve Trunk to Predict Postoperative Improvement in Hand Clumsiness in Patients With Cervical Spondylotic Myelopathy

Murata

Takami

Endô³

et al. 2022

Spine

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Study Design. A prospective cohort study Objective. To investigate whether the immediate and short-term effects of preoperative electrical peripheral nerve stimulation (ePNS) on performance of the 10-second test could predict the early postoperative outcomes of patients with cervical spondylotic myelopathy (CSM). Summary of Background Data. Previous studies have shown that early clinical improvement in CSM patients may be because of reversal of spinal cord ischemia after spinal cord compression. Materials and Methods. We conducted a 10-second test before surgery, after ePNS, and at discharge (one week after surgery) in 44 patients with CSM who underwent C3-C7 laminoplasty and evaluated their correlations. The effects of the procedures (ePNS or operation) and sides (stimulated or nonstimulated side) for the 10-second test were analyzed using repeated measures analysis of variance. The Pearson correlation coefficient was used to measure the relationship between the 10-second test values according to the method (after ePNS vs. surgery). In addition, the Bland-Altman method was used to evaluate the degree of agreement between the 10-second test obtained after ePNS versus shortly after surgery. Results. The preoperative 10-second test showed the most improvement immediately after the administration of ePNS, with a gradual decrease for the first 30 minutes after completion. After the initial 30 minutes, performance decreased rapidly, and by 60 minutes performance essentially returned to baseline. The 10-second post-ePNS had a strong positive correlation with the 10-second test in the early postoperative period (at discharge=one week after surgery). These phenomena were observed with the left hand, the side stimulated with ePNS, as well as the right hand, the side not stimulated. Conclusions. Early postoperative outcomes after CSM surgery may be predicted by the results of preoperative ePNS. Level of Evidence. Level 3

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Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Using Electrical Stimulation of the Ulnar Nerve Trunk to Predict Postoperative Improvement in Hand Clumsiness in Patients With Cervical Spondylotic Myelopathy

Murata

Takami

Endô³

et al. 2022

Spine

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“…In contrast, another study suggests that it is caused by iatrogenic foraminal stenosis during cervical lordosis correction [ 11 ]. Some authors believe it is related to symptom duration or a long period of subclinical disease before intervention [ 12 ]. Many studies confirmed that preoperative foramen size is the most significant independent risk factor for C5 palsy [ 4 , 13 ], but others assume it results from iatrogenic injury during decompression [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

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

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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.

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Tratamiento quirúrgico de las estenosis centrales del conducto cervical

Khalifé,

Guigui,

Hoffmann

et al. 2023

EMC - Técnicas Quirúrgicas - Ortopedia y Traumatología

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Preoperative electrophysiologic assessment of C5-innervated muscles in predicting C5 palsy after posterior cervical decompression

Cited by 6 publications

References 22 publications

Using Electrical Stimulation of the Ulnar Nerve Trunk to Predict Postoperative Improvement in Hand Clumsiness in Patients With Cervical Spondylotic Myelopathy

Using Electrical Stimulation of the Ulnar Nerve Trunk to Predict Postoperative Improvement in Hand Clumsiness in Patients With Cervical Spondylotic Myelopathy

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

Tratamiento quirúrgico de las estenosis centrales del conducto cervical

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