Risk factors for C5 palsy following the posterior spinal process-splitting laminoplasty for cervical ossification of the posterior longitudinal ligament: a case control study

Li, Nan; Zhao, Kaiping; An, Yan; Ke, Yan; Liu, Bo; He, Da

doi:10.21037/atm-22-1730

Cited by 2 publications

(5 citation statements)

References 27 publications

(24 reference statements)

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“…The incidences of C5 palsy after EOLP and CLF reported in this study are lower than what has typically been reported in the literature. 17,18 A similar incidence of C5 palsy was seen with CLF (2.7%) with no side preference. The overall complication rate and severity were higher in the CLF group, as was the age distribution in this nonrandomized series.…”

Section: Discussionmentioning

confidence: 60%

“…A study by Uzunoglu et al 17 revealed that patients with OPLL had a higher incidence of C5 palsy (17.3%) than those with other clinical diagnoses prior to surgery in the rest of the study, which had a combined incidence of 12.4%. EOLP for OPLL was also found to have a higher rate of C5 palsy in other studies, including those by Khuyagbaatar et al, 22 Wang et al, 16 Li et al, 18 and Deshpande et al 19 Several causative factors for C5 palsy have been suggested, such as iatrogenic nerve damage, thermal damage during drilling of the bone, stretching of nerve roots due to displacement of the spinal cord, compression of the root within the stenotic foramina, and ischemic-reperfusion injury of the spinal cord; however, the exact pathophysiology has yet to be identified. 14,15,17,[20][21][22] In this study, we focused on the question as to whether hinge sidedness is important in determining the laterality of C5 palsy.…”

mentioning

confidence: 56%

“…A multitude of studies in recent decades have investigated the relationship between expansile open-door cervical laminoplasties and C5 palsies. 14,[16][17][18]20,21,23 The incidence of C5 palsy after laminoplasty has been reported to vary from 1.4% to 23%. [23][24][25] However, there has yet to be an investigation into the relationship between the hinge side of the laminoplasty and the sidedness of the postoperative C5 palsy.…”

Section: Discussionmentioning

confidence: 99%

“…This study did not consider factors that have been shown in other studies to have a statistically significant effect on the occurrence of C5 after cervical laminoplasty in other studies such as Cobb angle, T1 slope, encroachment ratio if OPLL is present, presence of foraminal stenosis, degree of postoperative spinal cord posterior shift, enlargement of the C5 nerve root, high signal intensity on T2-weighted MRI, BMI, and other factors. 4,15,[18][19][20][21][22][23]25 Further investigations should be done using a prospective study that seeks to consider as many of the aforementioned variables as possible. This would be difficult to accomplish because of the low incidence of C5 palsy after EOLP.…”

Section: Limitations and Future Investigationmentioning

confidence: 99%

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Does hinge sidedness influence laterality of C5 palsy after expansile open-door cervical laminoplasty?

Levi,

Brusko,

Levi

et al. 2023

Neurosurgical Focus

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OBJECTIVE Cervical expansile open-door laminoplasties (EOLPs) have an open side and a hinge side, with the open side being bridged by grafts or miniplates. The authors explored the possibility that the open-door side might have a greater incidence of C5 palsy due to a greater stretch of the ipsilateral C5 nerve root. METHODS This study was a retrospective review of prospectively collected data over a period of 25 years specifically assessing surgical complications. Included were patients who underwent EOLP for myelopathy, radiculopathy, or mild central cord injuries (American Spinal Injury Association Impairment Scale [AIS] grade D). Exclusion criteria included preexisting C5 weakness; patients with AIS grade A, B, or C injury; and added instrumentation or additional surgical procedures. Patients were monitored postoperatively for C5 palsy or any other complications. A comparison group included patients who underwent cervical laminectomy and fusion (CLF). RESULTS A total of 327 laminoplasties were collected, and 31 patients were excluded because of severe spinal cord injury (AIS grades A–C), 3 for preoperative C5 weakness, and 21 for instrumentation or additional surgical procedures. Thus, 272 patients were analyzed with a mean age of 59.9 years (range 22–88 years). Diagnoses at presentation were cervical myelopathy (84.1%), central cord syndrome (7.2%), cervical myeloradiculopathy (3.4%), ossification of the posterior longitudinal ligament (1.9%), and other (3.4%). The most common complications were C5 palsy (n = 7, 2.6%) and wound infection (n = 7, 2.6%). Of the 7 cases of postoperative C5 palsies in this study, 6 occurred on the side of the open door. Of the C5 palsies, 2 were mild, 3 were moderate, and 2 were severe. Two of the 7 C5 palsies had a delayed (> 24 hours) onset. The C5 palsy incidence after CLF was 2.7% with no side preference. CONCLUSIONS C5 palsy after cervical decompression for myelopathy is a known occurrence, with a rate of 2.6% in the current study. The authors found that C5 palsies more commonly occur on the open side of the laminoplasty. This could be due to a greater manipulation of the nerve root on the side of the open door or greater stretch of the C5 root on the open-door side. If clinical symptoms and anatomical stenosis are symmetric, the authors recommend creating the laminoplasty hinge on the patient’s dominant side to minimize potential loss of dominant proximal arm function.

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Section: Discussionmentioning

confidence: 60%

mentioning

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Section: Limitations and Future Investigationmentioning

confidence: 99%

See 2 more Smart Citations

Does hinge sidedness influence laterality of C5 palsy after expansile open-door cervical laminoplasty?

Levi,

Brusko,

Levi

et al. 2023

Neurosurgical Focus

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“…The following outcomes were evaluated: operative time, blood loss, neurological state (assessed by the Japanese Orthopaedic Association [JOA] score), and JOA score recovery rate ([postoperative JOA score − preoperative JOA score]/[17 − preoperative JOA score] × 100%) [ 11 ]. All surgery-related events that occurred within 30 days after the operation were defined as perioperative complications, among which C5 palsy was defined as deltoid and biceps motor weakness, paresthesia, or numbness in the distribution of the C5 nerve root without deterioration of myelopathic symptoms [ 12 ].…”

Section: Methodsmentioning

confidence: 99%

Are clinical outcomes affected by laminoplasty method and K-line in patients with cervical ossification of posterior longitudinal ligament? A multicenter study

Duan

et al. 2022

J Orthop Surg Res

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Background Open-door laminoplasty (ODL) and French-door laminoplasty (FDL) are the main laminoplasty techniques used to treat cervical ossification of the posterior longitudinal ligament (C-OPLL). However, few studies have compared the outcomes of ODL and modified FDL (mFDL) for C-OPLL. We explored the differences in outcomes between ODL and mFDL for C-OPLL and analyzed the technical efficacy of each procedure in patients with K-line (+) or (−) C-OPLL. Methods From January 2010 to December 2015, 202 patients with K-line (+) or (−) C-OPLL were retrospectively recruited from 4 institutions. Clinical outcomes were evaluated using the Japanese Orthopaedic Association (JOA) score, JOA score recovery rate, operative time, blood loss, and complications. Univariate analysis and binary logistic regression models were adjusted for confounding factors. Results Two hundred patients (mFDL, n = 69; ODL, n = 131) with a median follow-up of 42 months (range 36–54 months) were included. The postoperative JOA score significantly improved in both groups (P < 0.05). After adjusting for confounding factors, there was a statistically significant difference in blood loss (≥ 300 mL) between the two groups (P = 0.005), but there was no significant difference in the postoperative JOA score (≥ 14) (P = 0.062), JOA score recovery rate (≥ 0.82) (P = 0.187), or operative time (≥ 90 min) (P = 0.925). C5 palsy tended to occur more often in the mFDL group, although the difference was not significant (P > 0.05). The stratified analysis of the K-line status showed more blood loss in K-line (+) patients who underwent mFDL, but there was no significant difference in the postoperative JOA score, JOA score recovery rate, or operative time between the ODL and mFDL groups. Additionally, there was no significant difference in blood loss, postoperative JOA score, JOA score recovery rate, or operative time among all patients with K-line (+) or (−) C-OPLL in both groups. Conclusions Both ODL and mFDL are effective for patients with C-OPLL. However, more blood loss tends to occur during mFDL. This study showed no significant difference in the operative time or incidence of complications between the two techniques. The efficacy of ODL and mFDL was not affected by the K-line status (+ or −) in patients with C-OPLL.

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Risk factors for C5 palsy following the posterior spinal process-splitting laminoplasty for cervical ossification of the posterior longitudinal ligament: a case control study

Cited by 2 publications

References 27 publications

Does hinge sidedness influence laterality of C5 palsy after expansile open-door cervical laminoplasty?

Does hinge sidedness influence laterality of C5 palsy after expansile open-door cervical laminoplasty?

Are clinical outcomes affected by laminoplasty method and K-line in patients with cervical ossification of posterior longitudinal ligament? A multicenter study

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