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Can prophylactic C4/5 foraminotomy prevent C5 palsy after cervical laminoplasty with and without posterior instrumented fusion with maximal expansion?

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Objective

To prospectively examine whether laminoplasty with maximal expansion induces C5 palsy, even with prophylactic bilateral C4/5 foraminotomy.

Methods

Thirty-five consecutive patients with cervical myelopathy underwent laminoplasty (n = 19: LP group) or posterior decompression and fusion (n = 16: PDF group) with maximal expansion. Prophylactic bilateral C4/5 foraminotomy was performed alternately in consecutive five patients undergoing each type of surgery. In each type of surgery, the first and third consecutive five patients did not undergo foraminotomy (NF subgroup: 20 patients), while the second and fourth consecutive five patients underwent foraminotomy (F subgroup: 15 patients). The widths between the gutters was equivalent to the diameter of the spinal canal, and an inclination angle of the lamina of approximately 90° was created during laminoplasty. The incidence and severity of postoperative C5 palsy were investigated. Patients with a manual muscle testing score for the deltoid muscle and/or biceps brachii muscle of ≤ 2 were diagnosed with severe palsy.

Results

The respective incidences of C5 palsy in the F and NF subgroups were 33% and 20% in the LP group and 50% and 20% in the PDF group. Severe palsy occurred in 67% and 0% of patients who had developed palsy in F and NF subgroups, respectively, in the LP group, and in 100% of patients in the PDF group. Furthermore, 40% of the patients with severe palsy took more than 6 months to recover.

Conclusions

Laminoplasty with maximal expansion induced C5 palsy in both the LP and PDF groups, even with the addition of prophylactic bilateral C4/5 foraminotomy.

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References

  1. Wang T, Wang H, Liu S, Ding W (2017) Incidence of C5 nerve root palsy after cervical surgery: a meta-analysis for last decade. Med 96:e8560. https://doi.org/10.1007/s00421-008-0955-8

    Article  Google Scholar 

  2. Blizzard DJ, Gallizzi MA, Sheets C, Klement MR, Kleeman LT, Caputo AM, Eure M, Brown CR (2015) The role of iatrogenic foraminal stenosis from lordotic correction in the development of C5 palsy after posterior laminectomy and fusion. J Orthop Surg Res. https://doi.org/10.1186/s13018-015-0297-2

    Article  PubMed  PubMed Central  Google Scholar 

  3. Cherian J, Mayer RR, Haroun KB, Winnegan LR, Omeis I (2016) Contribution of lordotic correction on C5 following cervical laminectomy and fusion. Neurosurg 79:816–822. https://doi.org/10.1227/NEU.0000000000001199

    Article  Google Scholar 

  4. Nakashima H, Imagama S, Yukawa Y, Kanemura T, Kamiya M, Yanase M, Ito K, Machino M, Yoshida G, Ishikawa Y, Matsuyama Y, Hamajima N, Ishiguro N, Kato F (2012) Multivariate analysis of C-5 palsy incidence after cervical posterior fusion with instrumentation. J Neurosurg Spine 17(2):103–110. https://doi.org/10.3171/2012.4.SPINE11255

    Article  PubMed  Google Scholar 

  5. Miller JA, Lubelski D, Alvin MD, Benzel EC, Mroz TE (2014) C5 palsy after posterior cervical decompression and fusion: cost and quality-of-life implications. Spine J 14:2854–2860. https://doi.org/10.1016/j.spinee.2014.03.038

    Article  PubMed  Google Scholar 

  6. Shiozaki T, Otsuka H, Nakata Y, Yokoyama T, Takeuchi K, Ono A, Numasawa T, Wada K, Toh S (2009) Spinal cord shift on magnetic resonance imaging at 24 hours after cervical laminoplasty. Spine 34:274–279. https://doi.org/10.1097/BRS.0b013e318194e275

    Article  PubMed  Google Scholar 

  7. Nori S, Aoyama R, Ninomiya K, Yamane J, Kitamura K, Ueda S, Shiraishi T (2017) Cervical laminoplasty of limited width prevents postoperative C5 palsy: a multivariate analysis of 263 muscle-preserving posterior decompression cases. Eur Spine J 26:2393–2403. https://doi.org/10.1007/s00586-017-5202-8

    Article  PubMed  Google Scholar 

  8. Tsuji T, Matsumoto M, Nakamura M, Ishi K, Fujita N, Chiba K, Watanabe K (2017) Factors associated with postoperative C5 palsy after expansive open-door laminoplasty: retrospective cohort study using multivariable analysis. Eur Spine J 26:2410–2416. https://doi.org/10.1007/s00586-017-5223-3

    Article  PubMed  Google Scholar 

  9. Takeuchi K, Yokoyama T, Wada K, Kudo H (2019) Relationship between enlargement of the crosssectional area of the dural sac and neurological improvements after cervical laminoplasty differences between cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament. Spine Surg Relat Res 3:27–36

    Article  PubMed  Google Scholar 

  10. Sasai K, Saito T, Akagi S, Kato I, Ohnari H, Iida H (2003) Preventing C5 palsy after laminoplasty. Spine 28:1972–1977. https://doi.org/10.1097/01.BRS.0000083237.94535.46

    Article  PubMed  Google Scholar 

  11. Komagata M, Nishiyama M, Endo K, Ikegami H, Tanaka S, Imakire A (2004) Prophylaxis of C5 palsy after cervical expansive laminoplasty by bilateral partial foraminotomy. Spine J 4:650–655. https://doi.org/10.1016/j.spinee.2004.03.022

    Article  PubMed  Google Scholar 

  12. Katsumi K, Yamazaki A, Watanabe K, Ohhashi M, Shoji H (2012) Can prophylactic bilateral C4/C5 foraminotomy prevent postoperative C5 palsy after open-door laminoplasty?: a prospective study. Spine 37:748–754

    Article  PubMed  Google Scholar 

  13. Liu G, Reyes MR, Riew KD (2017) Why does C5palsy occur after prophylactic bilateral C4–5 foraminotomy in open-door cervical laminoplasty? A risk factor analysis. Glob Spine J 7:696–702. https://doi.org/10.1177/2192568217699191

    Article  Google Scholar 

  14. Ando M, Tamaki T, Matsumoto T, Maio K, Teraguchi M, Takiguchi N, Iwahashi H, Onishi M, Makagawa Y, Iwasaki H, Tsutsui S, Takami M, Yamada H (2019) Can postoperative deltoid weakness after cervical laminoplasty be prevented by using intraoperative neurophysiological monitoring? J Clin Monit Comput 33:123–132. https://doi.org/10.1007/s10877-018-0141-4

    Article  PubMed  Google Scholar 

  15. Fujiwara Y, Manabe H, Izumi B, Tanaka H, Kawai K, Tanaka N (2016) The efficacy of intraoperative neurophysiological monitoring using transcranial electrically stimulated muscle-evoked potentials (TcE-MsEPs) for predicting postoperative segmental upper extremity motor paresis after cervical laminoplasty. Clin Spine Surg 29:E188-195. https://doi.org/10.1097/BSD.0000000000000311

    Article  PubMed  PubMed Central  Google Scholar 

  16. Takeuchi K, Yokoyama T, Wada K, Kumagai G, Kudo H, Tanaka S, Asari T, Sasaki E, Fujita T, Fukutoku T, Koyama K, Ichinohe M, Ishibashi Y (2020) Improvement in the results of the simple-foot-tapping test and cross-sectional area of the dural sac in patients with C5 palsy after posterior cervical spine surgery. Eur J Orthop Surg Traumatol. https://doi.org/10.1007/s00590-020-02715-1

    Article  PubMed  Google Scholar 

  17. Takeuchi K, Yokoyama T, Numasawa T, Yamasaki Y, Kudo H, Itabashi T, Chin S, Wada K (2016) K-line (–) in the neck-flexed position in patients with ossification of the posterior longitudinal ligament is a risk factor for poor clinical outcome after cervical laminoplasty. Spine 41:1891–1895

    Article  PubMed  Google Scholar 

  18. Chiba K, Toyama Y, Matsumoto M, Maruiwa H, Watanabe M, Hirabayashi K (2002) Segmental motor paralysis after expansive open-door laminoplasty. Spine 27:2108–2115. https://doi.org/10.1097/01.BRS.0000025693.11896.B3

    Article  PubMed  Google Scholar 

  19. Zdeblick TA, Zou D, Warden KE, Mccabe R, Kunz D, Vanderby R (1992) Cervical stability after foraminotomy biomechanical in vitro analysis. J Bone Joint Surg Am 74(1):22–27

    Article  CAS  PubMed  Google Scholar 

  20. Takeuchi K, Yokoyama T, Numasawa T, Itabashi T, Yamasaki Y, Kudo H (2018) A novel posterior approach preserving three muscles inserted at C2 in multilevel cervical posterior decompression and fusion using C2 pedicle screws. Eur Spine J 27:1349–1357. https://doi.org/10.1007/s00586-017-5402-2

    Article  PubMed  Google Scholar 

  21. Imagama S, Matsuyama Y, Yukawa Y, Kawakami N, Kamiya M, Kanemura T, Ishiguro N (2010) C5 palsy after cervical laminoplasty: a multicenter study. J Bone Joint Surg Br 92:393–400. https://doi.org/10.1302/0301-620X.92B3.22786

    Article  CAS  PubMed  Google Scholar 

  22. Kudo H, Takeuchi K, Yokoyama T, Yamasaki Y, Wada K, Asari T, Otsuka H, Ishibashi Y (2019) Severe C8 or T1 symptoms after cervical laminoplasty and related factors are there any differences between C3–C6 laminoplasty and C3–C7 laminoplasty. Asian Spine J. https://doi.org/10.31616/asj.2018.0253

    Article  PubMed  PubMed Central  Google Scholar 

  23. Choi KC, Ahn Y, Kang BU, Ahn ST, Lee SH (2014) Motor palsy after posterior cervical foraminotomy: anatomical consideration. World Neurosurg. https://doi.org/10.1016/j.wneu.2011.03.043

    Article  PubMed  Google Scholar 

  24. Nassr A, Eck JC, Ponnappan RK, Zanoun RR, Donaldson WF, Kang JD (2012) The incidence of C5 palsy after multilevel cervical decompression procedures: a review of 750 consecutive cases. Spine 37(3):174–178

    Article  PubMed  Google Scholar 

  25. Kudo Y, Toyone T, Shirahata T, Ozawa T, Matsuoka JY, Inagaki K (2016) A case of successful foraminotomy for severe bilateral C5 Palsy following posterior decompression and fusion surgery for cervical ossification of posterior longitudinal ligament. Case Rep Orthop. https://doi.org/10.1155/2016/1250810

    Article  PubMed  PubMed Central  Google Scholar 

  26. Macki M, Alam R, Kerezoudis P, Gokaslan Z, Bydon A, Bydon M (2016) Manual muscle test at C5 palsy onset predicts the likelihood of and time to C5 palsy resolution. J Clin Neurosci 24:112–116

    Article  PubMed  Google Scholar 

  27. Sakaura H, Hosono N, Mukai Y, Ishii T, Yoshikawa H (2003) C5 palsy after decompression surgery for cervical myelopathy: review of the literature. Spine 28(21):2447–2451

    Article  PubMed  Google Scholar 

  28. Uematsu Y, Tokuhashi Y, Matsuzaki H (1998) Radiculopathyafter laminoplasty of the cervical spine. Spine 23:2057–2062

    Article  CAS  PubMed  Google Scholar 

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Funding

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Aomori City Hospital, 1-14-20, Katta, Aomori, 030-0821, Japan

    Yoshihito Yamasaki

  2. Department of Orthopedic Surgery, Odate Municipal General Hospital, 3-1 Yutaka-cho, Odate, Akita, 017-0885, Japan

    Kazunari Takeuchi & Toru Yokoyama

  3. Department of Orthopedic Surgery, Hachinohe City Hospital, 3-1-1 Tamukai, Hachinohe, Aomori, 031-8555, Japan

    Takuya Numasawa

  4. Department of Orthopedic Surgery, Hirosaki University School of Medicine, 53 Hon-cho, Hirosaki, Aomori, 036-8203, Japan

    Kanichiro Wada, Gentaro Kumagai, Hitoshi Kudo, Sunao Tanaka, Toru Asari & Yasuyuki Ishibashi

  5. Department of Orthopedic Surgery, Towada City Hospital, 14-8 nishijuunibann-cho, Towada, 034-0093, Japan

    Taito Itabashi

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  1. Yoshihito Yamasaki
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  2. Kazunari Takeuchi
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Contributions

Yoshihito Yamasaki wrote and prepared the manuscript, and all of the authors participated in the study design. All authors have read, reviewed, and approved the article.

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Correspondence to Yoshihito Yamasaki.

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This study was approved by the institutional ethics committee of Odate Municipal General Hospital (approval number 30-09).

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Yamasaki, Y., Takeuchi, K., Numasawa, T. et al. Can prophylactic C4/5 foraminotomy prevent C5 palsy after cervical laminoplasty with and without posterior instrumented fusion with maximal expansion?. Eur J Orthop Surg Traumatol 31, 1037–1046 (2021). https://doi.org/10.1007/s00590-020-02842-9

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