Preventing C5 Palsy After Laminoplasty

Sasai, Keisuke; Saito, Takanori; Akagi, Shigeo; Kato, Isashi; Ohnari, Hiroyuki; Iida, Hiroya

doi:10.1097/01.brs.0000083237.94535.46

Cited by 124 publications

(85 citation statements)

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“…Tethering of the nerve root is considered another possible reason for postoperative C5 palsy after cervical laminoplasty [23]. There are some common characteristics between the late postoperative neurological deficits in the present study and C5 palsy after cervical laminoplasty [24].…”

Section: Discussionsupporting

confidence: 55%

A late neurological complication following posterior correction surgery of severe cervical kyphosis

et al. 2010

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Though a possible cause of late neurological deficits after posterior cervical reconstruction surgery was reported to be an iatrogenic foraminal stenosis caused not by implant malposition but probably by posterior shift of the lateral mass induced by tightening screws and plates, its clinical features and pathomechanisms remain unclear. The aim of this retrospective clinical review was to investigate the clinical features of these neurological complications and to analyze the pathomechanisms by reviewing pre-and post-operative imaging studies. Among 227 patients who underwent cervical stabilization using cervical pedicle screws (CPSs), six patients who underwent correction of cervical kyphosis showed postoperative late neurological complications without any malposition of CPS (ND group). The clinical courses of the patients with deficits were reviewed from the medical records. Radiographic assessment of the sagittal alignment was conducted using lateral radiographs. The diameter of the neural foramen was measured on preoperative CT images. These results were compared with the other 14 patients who underwent correction of cervical kyphosis without late postoperative neurological complications (non-ND group). The six patients in the ND group showed no deficits in the immediate postoperative periods, but unilateral muscle weakness of the deltoid and biceps brachii occurred at 2.8 days postoperatively on average. Preoperative sagittal alignment of fusion area showed significant kyphosis in the ND group. The average of kyphosis correction in the ND was 17.6°per fused segment (range 9.7°-35.0°), and 4.5°( range 1.3°-10.0°) in the non-ND group. A statistically significant difference was observed in the degree of preoperative kyphosis and the correction angles at C4-5 between the two groups. The diameter of the C4-5 foramen on the side of deficits was significantly smaller than that of the opposite side in the ND group. Late postoperative neurological complications after correction of cervical kyphosis were highly associated with a large amount of kyphosis correction, which may lead foraminal stenosis and enhance posterior drift of the spinal cord. These factors may lead to both compression and traction of the nerves, which eventually cause late neurological deficits. To avoid such complications, excessive kyphosis correction should not be performed during posterior surgery to avoid significant posterior shift of the spinal cord and prophylactic foraminotomies are recommended if narrow neuroforamina were evident on preoperative CT images. Regardless of revision decompression or observation, the majority of this late neurological complication showed complete recovery over time.

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Section: Discussionsupporting

confidence: 55%

A late neurological complication following posterior correction surgery of severe cervical kyphosis

et al. 2010

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“…Si el desplazamiento es de todo el cilindro dural, ¿por qué los sínto-mas son unilaterales? Quizás otros mecanismos como una lesión radicular 8 o una estenosis foraminal previas 9 , en un lado, podrían hacer más sensible a la raíz correspondiente TABLA 1 -Medición de las raíces cervicales en mm ante cualquier desplazamiento. Actualmente no se descarta totalmente que la lesión sea medular 10 .…”

Section: Discussionunclassified

Longitud de las raíces cervicales en resonancia magnética: relación con la parálisis postoperatoria de la quinta raíz cervical

Mezzadri

Rimoldi

2010

Coluna/Columna

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“…Another complication relating to the laminoplasty tech nique is the observance of C5 radiculopathy, which proba bly results from traction on the nerve, as the cord migrates dorsally after decompression. In published studies, this par ticular complication rate varies from 5% to 14% [22][23][24][25] . Sasai et al 25 discussed the role of prophylactic foraminotomies in de creasing the incidence of motor palsy after laminoplasties.…”

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confidence: 97%

“…In published studies, this par ticular complication rate varies from 5% to 14% [22][23][24][25] . Sasai et al 25 discussed the role of prophylactic foraminotomies in de creasing the incidence of motor palsy after laminoplasties. Lee et al 1 performed concomitant foraminotomies in 11 of 105 patients undergoing open-door laminoplasties and re ported improvements in 10 of 11 patients (91%).…”

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confidence: 97%

“…Other published series have reported similar results: Wang et al 3 reported an increase from 9.8 mm to 16.6 mm; O`Brien et al 23 reported an increase from 8.2 mm to 16.6 mm; and Satomi et al 24 reported an increase from 12.0 mm to 15.7 mm. Kyphotic sagittal alignments reportedly developed in 0-10% of patients after laminoplasty, depending on the se ries [25][26][27][28][29][30] . Iwasaki et al 26 reported a deterioration of cervical lordosis into kyphosis in 5 patients (8%) of 59 without neu rological sequelae.…”

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confidence: 99%

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A new expansive two-open-doors laminoplasty for multilevel cervical spondylotic myelopathy: technical report and follow-up results

Arantes

Silva

Malheiros

et al. 2014

Arq. Neuro-Psiquiatr.

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Cervical degenerative myelopathy is a common condi tion affecting 2% of all hospital admissions according to a number of studies 1,2 . The two main causes of this condition are cervical spondylosis and ossification of the posterior longitudinal ligament (OPLL) 3 . Such conditions progress with age and can eventually result in the impairment of mul tilevel segments and multilevel cervical spondylotic mye lopathy (MCSM). ABSTRACT:The laminoplasty technique was devised by Hirabayashi in 1978 for patients diagnosed with multilevel cervical spondylotic myelopathy. Objective: To describe an easy modification of Hirabayashi's method and present the clinical and radiological results from a five-year followup study. Method and Results: Eighty patients had 5 levels of decompression (C3-C7), 3 patients had 6 levels of decompression (C2-T1) and 3 patients had 4 levels of decompression (C3-C6). Foraminotomies were performed in 23 cases (27%). Following Nurick`s scale, 76 patients (88%) improved, 9 (11%) had the same Nurick grade, and one patient worsened and was advised to undergo another surgical procedure. No deaths were observed. The mean surgery time was 122 min. Radiographic evaluation showed an increase in the mean sagittal diameter from 11.2 mm at pretreatment to 17.3 mm post surgery. There was no significant difference between pretreatment and post-surgery C2-C7 angles. Conclusions:This two-open-doors laminoplasty technique is safe, easy and effective and can be used as an alternative treatment for cases of multilevel cervical spondylotic myelopathy without instability.Keywords: laminoplasty, cervical spondylotic myelopathy, ossification of the posterior longitudinal ligament. RESUMO:A laminoplastia é técnica clássica descrita por Hirabayashi em 1978 para descompressão do canal cervical sem utilizar prótese. A principal indicação é o tratamento da mielopatia espondilotica cervical sem instabilidade. Objetivo: Descrever modificação simples da técnica de laminoplastia clássica de Hirabayashi com resultados clínicos e radiográficos em 5 anos de acompanhamento. Resultados e Método: Foram acompanhados 86 pacientes. Em 80, foi feita descompressão por laminoplastia em 5 níveis (C3-C7); em 3, descompressão em 6 níveis (C2-T1); em 3, descompressao em 4 níveis (C3-C6). Em 23 casos (27%), foi realizada foraminotomia associada a descompressão medular. O acompanhamento dos pacientes foi feito utilizando a escala de Nurick. Em 76 pacientes (88%) houve melhora do grau de Nurick. Não houve mortalidade associada à técnica. O tempo médio do procedimento cirúrgico foi de 122 minutos. Em relação à avaliação radiográfica, houve aumento do diâmetro sagital médio do canal cervical de 11,2mm para 17,3mm. Não houve diferença estatística do ângulo C2-C7 nas avaliações antes e após o procedimento cirúrgico. Conclusão: A nova técnica de laminoplastia descrita no presente estudo foi segura, de fácil execução, efetiva, não utiliza protese e não há instabilidade do canal cervical.Palavras-chave: laminoplastia, mielopatia espondilotica cervical,...

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Preventing C5 Palsy After Laminoplasty

Cited by 124 publications

References 19 publications

A late neurological complication following posterior correction surgery of severe cervical kyphosis

A late neurological complication following posterior correction surgery of severe cervical kyphosis

Longitud de las raíces cervicales en resonancia magnética: relación con la parálisis postoperatoria de la quinta raíz cervical

A new expansive two-open-doors laminoplasty for multilevel cervical spondylotic myelopathy: technical report and follow-up results

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