Spinal Cord Shift on Magnetic Resonance Imaging at 24 Hours After Cervical Laminoplasty

Shiozaki, Takashi; Otsuka, Hironori; Nakata, Yoshihiro; Yokoyama, T.; Takeuchi, Kazunari; Ono, Atsushi; Numasawa, Takuya; Wada, Kanichiro; Toh, Satoshi

doi:10.1097/brs.0b013e318194e275

Cited by 81 publications

(45 citation statements)

References 11 publications

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“…The most commonly cited and accepted theory for C5 nerve palsy is the 'tethering effect', whereby it is believed that an increase in posterior shift of the thecal sac after decompression of the spinal canal and restoration of anatomic lordosis puts tension on the exiting C5 nerve root and, either by ischemia or neuropraxia, causes injury. 1,[6][7][8][9] This theory is further supported by the equivalent rates of C5 palsy after both anterior and posterior cervical decompression. While the two approaches vary in technique, they both decompress the spinal canal and restore lordosis allowing for posterior shift of the thecal sac and tension on the C5 nerve root.…”

Section: Discussionsupporting

confidence: 57%

Bilateral C5 Motor Palsy after Anterior Cervical Decompression and Fusion: A Case Report and Review of the Literature

et al. 2017

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Section: Discussionsupporting

confidence: 57%

Bilateral C5 Motor Palsy after Anterior Cervical Decompression and Fusion: A Case Report and Review of the Literature

et al. 2017

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“…Another possible cause was tethering of the root after creating lordosis, which happened when the spinal cord of a patient who had posterior decompression and postoperative neurological complications shifted posteriorly by more than 5 mm during the first 24 h [22]. Takemitsu et al [20] showed that postoperative neurological deficits were detected in 50% of patients who underwent cervical spinal reconstructions using lateral mass screws and pedicle screws.…”

Section: Discussionmentioning

confidence: 99%

“…The common features were: (1) late onset after surgery, (2) unilateral weakness of the deltoid and biceps brachii muscles with or without sensory disturbance, and (3) preceding severe pain of the neck and scapular arch. Tethering of the nerve root is thought to be due to the posterior shift of the spinal cord [22]. When kyphosis of the cervical spine is corrected, the posterior shift of the spinal cord might be larger than that of cervical laminoplasty alone [25].…”

Section: Discussionmentioning

confidence: 99%

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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“…A relative mean improvement of 1.9 mm is then typically observed by 2 weeks. 7 Moreover, in the same study, in cases of C-5 palsy, dorsal displacement undergoes a greater positional change, drifting up to 5.5 mm whereby a decrease to about 3 mm can be seen at 2 weeks. 7 The gradual ventral rebound may explain the typical improvement that is observed.…”

Section: Discussionmentioning

confidence: 92%

C-5 palsy after cerebrospinal fluid diversion in posttraumatic syringomyelia: case report

Ghobrial¹,

Beygi²,

Viereck³

et al. 2015

SPI

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Syringomyelia is a potentially debilitating disease that involves abnormal CSF flow mechanics; its incidence after traumatic spinal cord injury (SCI) is approximately 15%. Treatment consists of restoration of CSF flow, typically via arachnoidolysis and syrinx decompression. The authors present a case of pronounced syringomyelia in a patient with concomitant severe cervical myelomalacia to demonstrate unilateral C-5 palsy as a potential complication of aggressive syrinx decompression at a remote level. A 56-year-old man with a remote history of SCI at T-11 (ASIA [American Spinal Injury Association] Grade A) presented with complaints of ascending motor and sensory weakness into the bilateral upper extremities that had progressed over 1 year. MRI demonstrated severe distortion of the spinal cord at the prior injury level of T10–11, where an old anterior column injury and prior hook-rod construct was visualized. Of note, the patient had a holocord syrinx with demonstrable myelomalacia. To restore CSF flow and decompress the spinal cord, T-2 and T-3 laminectomies, followed by arachnoidolysis and syringopleural shunt placement, were performed. Postoperatively on Day 1, with the exception of a unilateral deltoid palsy, the patient had immediate improvement in upper-extremity strength and myelopathy. He was discharged from the hospital on postoperative Day 5; however, at his 2-week follow-up visit, a persistent unilateral deltoid palsy was noted. MRI demonstrated a significant reduction in the holocord syrinx, no neural foraminal stenosis, and a significant positional shift of the ventral spinal cord. Further motor recovery was noted at the 8-month follow-up. Syringomyelia is a debilitating disease arising most often as a result of traumatic SCI. In the setting of myelomalacia with a pronounced syrinx, C-5 palsy is a potential complication of syrinx decompression.

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Spinal Cord Shift on Magnetic Resonance Imaging at 24 Hours After Cervical Laminoplasty

Abstract: The posterior shift of the spinal cord at 24 hours had a tendency to shift more posteriorly than that observed at 2 weeks after cervical laminoplasty. C5 palsy may be prevented if the expansion of dura mater, which is strongly correlated with the posterior shift, can be controlled.

Cited by 81 publications

References 11 publications

Bilateral C5 Motor Palsy after Anterior Cervical Decompression and Fusion: A Case Report and Review of the Literature

Bilateral C5 Motor Palsy after Anterior Cervical Decompression and Fusion: A Case Report and Review of the Literature

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

C-5 palsy after cerebrospinal fluid diversion in posttraumatic syringomyelia: case report

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