Significant reduction in the incidence  of C5 palsy after cervical laminoplasty using chilled irrigation  water

Takenaka, Shota; Hosono, Noboru; Mukai, Yoshihiro; Tateishi, Kosuke; Fuji, Takeshi

doi:10.1302/0301-620x.98b1.36042

Cited by 34 publications

(11 citation statements)

References 24 publications

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“…27 They have thus advised the use of chilled irrigation during surgery. 28 The authors of this investigation, however, find the hypothesis of a thermal mechanism of injury hard to reconcile with the typical delayed appearance of deficit. Indeed, a thermal injury to the C5 root should be an intraoperative injury expected to be clearly identifiable on intraoperative neuromonitoring and apparent clinically in the recovery room immediately following surgery, something not seen in any patient in this series.…”

Section: Mechanism Of Injurymentioning

confidence: 75%

Patterns of neurological deficits and recovery of postoperative C5 nerve palsy

Houten

Buksbaum²,

Collins

2020

Journal of Neurosurgery: Spine

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OBJECTIVEParesis of the C5 nerve is a well-recognized complication of cervical spine surgery. Numerous studies have investigated its incidence and possible causes, but the specific pattern and character of neurological deficits, time course, and relationship to preoperative cord signal changes remain incompletely understood.METHODSRecords of patients undergoing cervical decompressive surgery for spondylosis, disc herniation, or ossification of the longitudinal ligament, including the C4–5 level, were reviewed from a 15-year period, identifying C5 palsy cases. Data collected included age, sex, diabetes and smoking statuses, body mass index, surgical levels, approach, presence of increased cord signal intensity, and modified Japanese Orthopaedic Association (mJOA) scores. Narrative descriptions of the patterns and findings on neurological examination were reviewed, and complications were noted. The minimum follow-up requirement for the study was 12 months.RESULTSOf 642 patients who underwent cervical decompressive surgery, 18 developed C5 palsy (2.8%). The incidence was significantly lower following anterior surgery (6 of 441 [1.4%]) compared with that following cervical laminectomy and fusion (12 of 201 [6.0%]) (p < 0.001). There were 10 men and 8 women whose mean age was 66.7 years (range 54–76 years). The mean preoperative mJOA score of 11.4 improved to 15.6 at the latest follow-up examination. There were no differences between those with and without C5 palsy with regard to sex, age, number of levels treated, or pre- or postoperative mJOA score. Fifteen patients with palsy (83%) had signal changes/myelomalacia on preoperative T2-weighted imaging, compared with 436 of 624 (70%) patients without palsy; however, looking specifically at the C4–5 level, signal change/myelomalacia was present in 12 of 18 (67%) patients with C5 palsy, significantly higher than in the 149 of 624 (24%) patients without palsy (p < 0.00003). Paresis was unilateral in 16 (89%) and bilateral in 2 (11%) patients. All had deltoid weakness, but 15 (83%) exhibited new biceps weakness, 8 (44%) had triceps weakness, and 2 (11%) had hand intrinsic muscle weakness. The mean time until onset of palsy was 4.6 days (range 2–14 days). Two patients (11%) complained of shoulder pain preceding weakness; 3 patients (17%) had sensory loss. Recovery to grade 4/5 deltoid strength occurred in 89% of the patients. No patient had intraoperative loss of somatosensory or motor evoked potentials or abnormal intraoperative C5 electromyography activity.CONCLUSIONSPostoperative C5 nerve root dysfunction appears in a delayed fashion, is predominantly a motor deficit, and weakness is frequently appreciated in the biceps and triceps muscles in addition to the deltoid muscle. Preoperative cord signal change/myelomalacia at C4–5 was a significant risk factor. No patient had a detectable deficit in the immediate postoperative period or changes in intraoperative neuromonitoring status. Neurological recovery to at least that of grade 4/5 occurred in nearly 90% of the patients.

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Section: Mechanism Of Injurymentioning

confidence: 75%

Patterns of neurological deficits and recovery of postoperative C5 nerve palsy

Houten

Buksbaum²,

Collins

2020

Journal of Neurosurgery: Spine

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“…Other proposed mechanisms are due to the iatrogenic injury during surgery as spinal cord ischemia and reperfusion injury. Takenaka et al (17) proposed the use of chilled saline irrigation during bone drilling in order to reduce this damage. On the other hand, an intraoperative nerve root injury has been ruled out by Tanaka et al (18) who monitored the intraoperative evoked potentials and no abnormalities were seen even in those patients who developed postoperative C5P.…”

Section: Discussionmentioning

confidence: 99%

C5 palsy after insertion of a winged expandable cervical cage: a case report and literature review

et al. 2017

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C5 nerve root palsy is a well-known complication after anterior or posterior cervical decompression. Many theories have been proposed but the etiology is still unclear. The use of a winged expandable cage after single or multiple corpectomy is among the used techniques in reconstructing the cervical spine. Herein we report a case of C5 palsy after a three-level corpectomy and reconstruction using this device for the treatment of cervical spondylosis. In our case the preexisting foraminal stenosis, wide anterior decompression and partial improvement of cervical alignment were factors supposed contributing to the palsy.

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“…During surgery, the spinal cord and/or the nerve root may be damaged by the direct compression of a retractor and/or high friction heat of the tip of an air-drill 91) . After surgery, the spinal cord and/or the nerve root may be distracted and/ or compressed by adjacent anatomical structures, such as the facet joint and the vertebral body under a new circumstance, in which the cervical spine alignment is more or less changed, especially when the patients start rehabilitation after bed rest.…”

Section: B Postoperative C5 Palsymentioning

confidence: 99%

Development and Achievement of Cervical Laminoplasty and Related Studies on Cervical Myelopathy

Hirabayashi

Kitagawa

Yamamoto

et al. 2020

Spine Surg Relat Res

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Cervical laminoplasty (CL) is one of the surgical methods via the posterior approach for treating patients with multilevel affected cervical myelopathy (CM). The main purpose of CL is to decompress the cervical spinal cord by widening the narrowed spinal canal, combined with preserving the posterior anatomical structures to the degree possible and preserving the widened space stably. During the development and improvement of spine surgeries including CL, various studies on CM have progressed and useful achievements have been obtained: (1) posterior cervical spine fixation systems that can be used in combination with CL simultaneously have been developed; (2) various materials to stably maintain the enlarged spinal canal have been developed; (3) the main influential factors on the surgical results are the inner factors of the patients, such as the patient's age and the disease duration; (4) various surgical methods to preserve the function of the posterior cervical muscles have been tried to avoid postoperative kyphotic changes of the cervical spine; (5) postoperative complications, such as C5 palsy and axial pain, have been examined, and the countermeasures have been tried; (6) K-line on lateral X-ray films has been applied to evaluate the indication of CL in patients with CM due to ossification of the posterior longitudinal ligament (OPLL) preoperatively; and (7) the method and idea of CL have been adapted to surgeries at the thoracic and lumbar spine. However, some issues remain to be resolved, such as the deterioration of neurological findings, especially in patients with continuous or mixed-type OPLL, the postoperative kyphotic-directional alignment change of the cervical spine, C5 palsy, and axial pain.

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Significant reduction in the incidence of C5 palsy after cervical laminoplasty using chilled irrigation water

Abstract: Chilled irrigation during laminoplasty reduces C5 palsy.

Cited by 34 publications

References 24 publications

Patterns of neurological deficits and recovery of postoperative C5 nerve palsy

Patterns of neurological deficits and recovery of postoperative C5 nerve palsy

C5 palsy after insertion of a winged expandable cervical cage: a case report and literature review

Development and Achievement of Cervical Laminoplasty and Related Studies on Cervical Myelopathy

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