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C5 nerve palsy after posterior reconstruction surgery: predictive risk factors of the incidence and critical range of correction for kyphosis

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Abstract

Purpose

It has been reported that the incidence of post-operative segmental nerve palsy, such as C5 palsy, is higher in posterior reconstruction surgery than in conventional laminoplasty. Correction of kyphosis may be related to such a complication. The aim of this study was to elucidate the risk factors of the incidence of post-operative C5 palsy, and the critical range of sagittal realignment in posterior instrumentation surgery.

Methods

Eighty-eight patients (mean age 64.0 years) were involved. The types of the disease were; 33 spondylosis with kyphosis, 27 rheumatoid arthritis, 17 athetoid cerebral palsy and 11 others. The patients were divided into two groups; Group P: patients with post-operative C5 palsy, and Group NP: patients without C5 palsy. The correction angle of kyphosis, and pre-operative diameter of C4/5 foramen on CT were evaluated between the two groups. Multivariate logistic regression analysis was used to determine the critical range of realignment and the risk factors affecting the incidence of post-operative C5 palsy.

Results

Seventeen (19.3 %) of the 88 patients developed C5 palsy. The correction angle of kyphosis in Group P (15.7°) was significantly larger than that in Group NP (4.5°). In Group P, pre-operative diameters of intervertebral foramen at C4/5 (3.2 mm) were significantly smaller than those in Group NP (4.1 mm). The multivariate analysis demonstrated that the risk factors were the correction angle and pre-operative diameter of the C4/5 intervertebral foramen. The logistic regression model showed a correction angle exceeding 20° was critical for developing the palsy when C4/5 foraminal diameter reaches 4.1 mm, and there is a higher risk when the C4/5 foraminal diameter is less than 2.7 mm regardless of any correction.

Conclusions

This study has indicated the risk factors of post-operative C5 palsy and the critical range of realignment of the cervical spine after posterior instrumented surgery.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan

    Takuto Kurakawa

  2. Department of Orthopaedic Surgery, Kindai University Faculty of Medicine, 377-2, Ohnohigashi, Osaka-Sayama, Osaka, Japan

    Hiroshi Miyamoto

  3. Department of Orthopaedic Surgery, Kobe Rosai Hospital, Kobe, Japan

    Shuichi Kaneyama & Masatoshi Sumi

  4. Department of Orthopaedic Surgery, National Hospital Organization Kobe Medical Center, Kobe, Japan

    Koki Uno

Authors
  1. Takuto Kurakawa
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  2. Hiroshi Miyamoto
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  3. Shuichi Kaneyama
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  4. Masatoshi Sumi
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  5. Koki Uno
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Corresponding author

Correspondence to Hiroshi Miyamoto.

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The authors declare no potential conflict of interest concerning the materials or methods used in this study or the findings specified in this study.

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Kurakawa, T., Miyamoto, H., Kaneyama, S. et al. C5 nerve palsy after posterior reconstruction surgery: predictive risk factors of the incidence and critical range of correction for kyphosis. Eur Spine J 25, 2060–2067 (2016). https://doi.org/10.1007/s00586-016-4548-7

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  • DOI: https://doi.org/10.1007/s00586-016-4548-7

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