Quantitative measures of functional outcomes and quality of life in patients with C5 palsy

Chang, Po Yao; Chan, Rai-Chi; Tsai, Yun An; Huang, Wen Cheng; Cheng, Henrich; Wang, Jia Chi; Huang, Shih Fong

doi:10.1016/j.jcma.2013.03.008

Cited by 19 publications

(17 citation statements)

References 26 publications

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“…As a large review recently stated, there is no overall statistical difference between anterior or posterior approaches, although some groups describe a significantly higher incidence in posterior procedures[ 21 , 28 ], as reported here. Nevertheless, considering all of the results of the larger studies, there is a trend towards the anterior approach surgeries to represent the safer strategy referring to C5 palsy rates compared to posterior procedures[ 23 ].…”

Section: Discussionsupporting

confidence: 55%

Impact of the surgical strategy on the incidence of C5 nerve root palsy in decompressive cervical surgery

et al. 2017

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ObjectiveOur aim was to identify the impact of different surgical strategies on the incidence of C5 palsy.BackgroundDegenerative cervical spinal stenosis is a steadily increasing morbidity in the ageing population. Postoperative C5 nerve root palsy is a common complication with severe impact on the patients´ quality of life.MethodsWe identified 1708 consecutive patients who underwent cervical decompression surgery due to degenerative changes. The incidence of C5 palsy and surgical parameters including type and level of surgery were recorded to identify predictors for C5 nerve palsy.ResultsThe overall C5 palsy rate was 4.8%, with 18.3% of cases being bilateral. For ACDF alone the palsy rate was low (1.13%), compared to 14.0% of C5 palsy rate after corpectomy. The risk increased with extension of the procedures. Hybrid constructs with corpectomy plus ACDF at C3-6 showed significantly lower rates of C5 palsy (10.7%) than corpectomy of two vertebrae (p = 0.005). Multiple regression analysis identified corpectomy of C4 or C5 as a significant predictor. We observed a lower overall incidence for ventral (4.3%) compared to dorsal (10.9%) approaches (p<0.001). When imaging detected a postoperative shift of the spinal cord at index segment C4/5, palsy rate increased significantly (33.3% vs. 12.5%, p = 0.034).ConclusionsExtended surgical strategies, such as dorsal laminectomies, multilevel corpectomies and procedures with extensive spinal cord shift were shown to display a high risk of C5 palsy. The use of extended procedures should therefore be employed cautiously. Switching to combined surgical methods like ACDF plus corpectomy can reduce the rate of C5 palsy.

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Section: Discussionsupporting

confidence: 55%

Impact of the surgical strategy on the incidence of C5 nerve root palsy in decompressive cervical surgery

et al. 2017

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“…Bydon et al [ 84 ] reported on comparison between anterior and posterior approaches, the incidence of C5 palsy was significantly higher in the posterior method than the anterior method (8.6% vs 1.6%) ( P <.001). Chang et al [ 40 ] performed another study to compare anterior and posterior approaches. In their study, the incidence of C5 palsy has been reported as 0.7% and 8.8% for anterior and posterior, respectively.…”

Section: Discussionmentioning

confidence: 99%

Incidence of C5 nerve root palsy after cervical surgery

Wang

Liu

et al. 2017

Medicine

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Purpose:We aim to perform a meta-analysis on incidence of C5 nerve root palsy (C5 palsy) for patients after cervical surgery.Methods:An extensive search of the literature was performed in PubMed/MEDLINE, Embase, the Cochrane library, CNKI, and WANFANG databases on incidence of C5 palsy from January 2007 to January 2017. Prevalence of C5 palsy related to different surgery methods was calculated and data analysis was conducted with STATA 12.0.Results:A total of 61 studies containing 721 patients with C5 palsy in total 11,481 patients (6.3%) were included in our study. The incidences after anterior cervical discectomy and fusion (ACDF), anterior cervical corpectomy and fusion (ACCF), anterior corpectomy combined with discectomy (ACCDF), laminoplasty (LP) and laminectomy and fusion (LF) were 5.5%, 7.5%, 6%, 4.4%, and 12.2%, respectively. Compared with anterior approaches (5%), female patients (4%) and patients with cervical spondylotic myelopathy (CSM) (4.8%), posterior approaches (6.2%), male patients (5.7%) and patients with ossification of posterior longitudinal ligament (OPLL) (8.1%) have a higher prevalence. In ACDF and LP, patients with OPLL (5.5%, 8.1%, respectively) have a higher incidence than those in patients with CSM (4.7%, 3.1%, respectively); however, in LF, patients with CSM and OPLL have similar incidence of C5 palsy (13% vs 13.1%). In most cases, C5 palsy was unilateral (74.5%).Conclusions:Based on our meta-analysis, posterior approaches, male patients and patients with OPLL have a higher incidence of C5 palsy. In ACDF and LP, patients with OPLL have a higher incidence of C5 palsy, but in LF, patients with CSM and OPLL have similar result.

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“…[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. Twenty-six out of the 28 included studies reported the risk factors for C5 palsy development (see Table 1).…”

Section: Clinical Featuresmentioning

confidence: 99%

C5 nerve root palsy after posterior cervical spine surgery

Fang

Wang

et al. 2017

J Orthop Surg (Hong Kong)

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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.

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Quantitative measures of functional outcomes and quality of life in patients with C5 palsy

Cited by 19 publications

References 26 publications

Impact of the surgical strategy on the incidence of C5 nerve root palsy in decompressive cervical surgery

Impact of the surgical strategy on the incidence of C5 nerve root palsy in decompressive cervical surgery

Incidence of C5 nerve root palsy after cervical surgery

C5 nerve root palsy after posterior cervical spine surgery

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