Why Does C5 Palsy Occur after Prophylactic Bilateral C4-5 Foraminotomy in Open-Door Cervical Laminoplasty? A Risk Factor Analysis

Liu, Gabriel; Reyes, Ma. Ramona; Riew, K. Daniel

doi:10.1055/s-0036-1582821

Cited by 6 publications

(20 citation statements)

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“…One study was judged good quality with low risk of bias (class of evidence [CoE] I), 41 6 fair quality with moderate risk of bias (CoE II), 20,29,31,32,39,42 and 9 studies were judged to be poor quality with moderately high risk of bias (CoE III). 14,15,28,30,33,38,40,43,44 The CoE rating, all risk factors abstracted, and a list of excluded articles can be found in the Supplemental Material (available in the online version of the article). The prevalence of C5P among studies in this review ranged from 1.6% to 24.1% (1.6% to 6.8% with the anterior approach, 4.2% to 24.1% with the posterior approach).…”

Section: Resultsmentioning

confidence: 99%

Factors Associated With C5 Palsy Following Cervical Spine Surgery: A Systematic Review

Jack

Ramey

Dettori

et al. 2019

Global Spine Journal

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Study Design: Systematic review. Objectives: C5 palsy (C5P) is a not uncommon and disabling postoperative complication with a reported incidence varying between 0% and 30%. Among others, one explanation for its occurrence includes foraminal nerve root tethering. Although different risk factors have been reported, controversy about its causation and prevention persists. Inconsistent study findings contribute to the persistent ambiguity leading to an assumption of a multifactorial nature of the underlying C5P pathophysiology. Here, we report the results of a systematic review on C5P with narrow inclusion criteria in the hope of elucidating risk factors for C5P due to a common pathophysiological mechanism. Methods: Electronic databases from inception to March 9, 2019 and references of articles were searched. Narrow inclusion criteria were applied to identify studies investigating demographic, clinical, surgical, and radiographic factors associated with postoperative C5P. Results: Sixteen studies were included after initial screening of 122 studies. Eighty-four risk factors were analyzed; 27 in ≥2 studies and 57 in single studies. The pooled prevalence of C5P was 6.0% (range: 4.2%-24.1%) with no consistent evidence that C5P was associated with demographic, clinical, or specific surgical factors. Of the radiographic factors assessed, specifically decreased foraminal diameter and preoperative cord rotation were identified as risk factors for C5P. Conclusion: Although risk factors for C5P have been reported, ambiguity remains due to potentially multifactorial pathophysiology and study heterogeneity. We found foraminal diameter and cord rotation to be associated with postoperative C5P occurrence in our meta-analysis. These findings support the notion that factors contributing to, and acting synergistically with foraminal stenosis increase the risk of postoperative C5P.

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Section: Resultsmentioning

confidence: 99%

Factors Associated With C5 Palsy Following Cervical Spine Surgery: A Systematic Review

Jack

Ramey

Dettori

et al. 2019

Global Spine Journal

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“…Liu et al 4 counted the number of rootlets in the dorsal and ventral roots of the spinal nerves using histological sections and reported that the C7 dorsal root contained the highest number of nerve fibers among the cervical roots. The result of the present study was consistent with Karatas et al 22 but contradicts Liu et al 4 ; the difference may be related to the different methods used in the 2 studies. The results of recent studies have shown that root reimplantation might become a treatment option in brachial plexus injuries.…”

Section: The Diameter Of Cervical Spinal Nerves Number Of Dorsal Roomentioning

confidence: 99%

“…The anatomy of the cervical spine, with its high physical mobility and its proximity to vital structures such as the vertebral artery and the cervical spinal nerves, makes this region clinically important. Surgery on the cervical spine is performed for tumors and metastases, 1,2 vertebral artery loop, 3,4 degenerative disease, and trauma. 5 During surgery in this region there is a potential risk of injuring the spinal cord, the vertebral artery, and the nerve roots.…”

Section: Introductionmentioning

confidence: 99%

Morphometric Study of the Cervical Spinal Canal Content and the Vertebral Artery

Aydoğmuş

Çavdar

2020

Int J Spine Surg

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Background: The morphological features of the cervical spinal nerves (C1-C8), their dimensions, and their anatomical relations with the vertebral artery are important for safe spinal surgery. The aim of the present study is to give detailed morphological data of the region to avoid complications. Methods: Five formalin-fixed adult cadavers were studied. The cervical spinal nerves and the vertebral artery were exposed via the posterior approach, and detailed anatomy and morphometric measurements were evaluated. The following measurements were documented: angles between the spinal nerve and the spinal cord of C1 to C8, width of the C1 to C8 spinal nerves at their origin, distance of the spinal cord to the vertebral artery, number of dorsal rootlets, length of the dorsal root entry zone of C1 to C8, and distance between respective spinal nerves. Further, the average length and width of the transverse foramen were measured. Results: The average angle between the spinal cord and the spinal nerve within the vertebral canal ranged between 54 and 87 degrees and were most acute at C5 (54 degrees) compared to the rest of the cervical spinal nerves. The average width of the spinal nerves (mean 6 SD), was thickest at C5 (5.7 6 1.2 mm) and C6 (5.8 6 0.7 mm). The average largest distance between the vertebral artery and the spinal cord was at C2 (14.3 6 1.7 mm) and the smallest at C5 (7.3 6 0.9 mm) and C6 (7.3 6 2.2 mm) spinal levels. The number of dorsal rootlets was most numerous at C6 (8.25 6 0.6) and C7 (7.25 6 0.9). The dorsal root entry zone length was the largest at C5 (13.0 6 1.6 mm) and C6 (13.75 6 0.5 mm). The distance between respective spinal nerves was largest between C2 and C3 (11.8 6 2.2) and C7 and C8 (11.5 6 0.6). Conclusion: The knowledge of detailed anatomy of the cervical spine (C1-C8) and its relations with the vertebral artery will reduce the unwanted damage to the vital structures of the region.

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“…Similarly, Wang et al [17] noted that ACDF using a stand-alone cage was associated with significantly less blood loss compared with a posterior approach, while operative time was similar for both procedures. A previous study shows that C5 nerve root palsy is more likely to happen in patients who undergo posterior decompression compared with ACDF following excessive spinal cord drift after laminectomy [24]; postoperative C5 palsy may also associate the presence of C4-5 high intensity cord signal changes or a long duration of symptoms [25]. In the meta-analysis by Shou et al [26], the highest prevalence of C5 palsy was noted among the patients who had laminectomy and fusion (11.0%), in contrast to (3.3%) in the ACDF group.…”

Section: Discussionmentioning

confidence: 97%

Multiple level anterior cervical discectomy and fusion versus posterior laminectomy for the management of multilevel cervical spondylotic myelopathy: clinical and radiological outcome

Ahmed

Galal

2020

Egypt J Neurol Psychiatry Neurosurg

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Background: Though both anterior and posterior approach are used for the management of multilevel cervical spondylotic myelopathy (CSM), the choice between both approaches remains to be of considerable debate. Aim of the work: The aim of the study was to evaluate the clinical and radiographic outcomes of patients with multiple level CSM who underwent posterior laminectomy (PL) versus anterior cervical discectomy and fusion (ACDF). Methods: This is a retrospective comparative study of 30 patients, with multiple level CSM managed by the authors, either by PL (n = 15) or ACDF (n = 15). Clinical outcome was assessed at 1, 3, 6, and 12 months postoperatively using the modified Japanese Orthopedic Association scale (mJOA) while the postoperative radiographic changes represented by the Cobb's angle variation was recorded at 12 months postoperatively and compared with preoperative values. Also, the incidence of postoperative complications and neurological deterioration was recorded and studied between the two groups. Study duration was for 2 years from December 2014 to December 2016. Results: Both the ACDF and PL groups showed an improvement in the mJOA score mean value at 1 year after surgery in comparison with the preoperative evaluation data; however, on comparing between both groups at 1 year postoperatively, the median percent of increase in mJOA score was significantly higher in the ACDF group compared with the PL group (33.3% vs 22.2% respectively). On the other hand, the Cobb's angle percent of change 1 year after surgery showed a median percent of increase of 18.7% in the ACDF group in contrast to a median decrease of − 11.1% in the PL group which was statistically significant. Minimal complications were reported in both groups. Conclusion: Both PL and ACDF are effective modalities for the surgical management of multilevel CSM showing good clinical outcome; however, when compared with the posterior approach, there was a statistical significant difference favoring ACDF regarding the median percent of increase in mJOA score and the postoperative Cobb's angle improvement.

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Why Does C5 Palsy Occur after Prophylactic Bilateral C4-5 Foraminotomy in Open-Door Cervical Laminoplasty? A Risk Factor Analysis

Abstract: Introduction Prophylactic bilateral foraminotomy has been shown to reduce the risk of C5 palsy after open-door laminoplasty surgery. However, it does not totally eliminate it. Other factors such as inherent cord pathology may play a role in its development.

Cited by 6 publications

References 0 publications

Factors Associated With C5 Palsy Following Cervical Spine Surgery: A Systematic Review

Factors Associated With C5 Palsy Following Cervical Spine Surgery: A Systematic Review

Morphometric Study of the Cervical Spinal Canal Content and the Vertebral Artery

Multiple level anterior cervical discectomy and fusion versus posterior laminectomy for the management of multilevel cervical spondylotic myelopathy: clinical and radiological outcome

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