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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References
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. doi:10.1097/01.BRS.0000090833.96168.3F
Yonenobu K, Hosono N, Iwasaki M, Asano M, Ono K (1991) Neurologic complications of surgery for cervical compression myelopathy. Spine 16(11):1277–1282
Hasegawa K, Homma T, Chiba Y (2007) Upper extremity palsy following cervical decompression surgery results from a transient spinal cord lesion. Spine 32(6):E197–E202. doi:10.1097/01.brs.0000257576.84646.49
Kaneko K, Hashiguchi A, Kato Y, Kojima T, Imajyo Y, Taguchi T (2006) Investigation of motor dominant C5 paralysis after laminoplasty from the results of evoked spinal cord responses. J Spinal Disord Tech 19(5):358–361. doi:10.1097/01.bsd.0000210112.09521.e3
O’Shaughnessy BA, Liu JC, Hsieh PC, Koski TR, Ganju A, Ondra SL (2008) Surgical treatment of fixed cervical kyphosis with myelopathy. Spine 33(7):771–778. doi:10.1097/BRS.0b013e3181695082
Abumi K, Shono Y, Ito M, Taneichi H, Kotani Y, Kaneda K (2000) Complications of pedicle screw fixation in reconstructive surgery of the cervical spine. Spine 25(8):962–969
Takemitsu M, Cheung KM, Wong YW, Cheung WY, Luk KD (2008) C5 nerve root palsy after cervical laminoplasty and posterior fusion with instrumentation. J Spinal Disord Tech 21(4):267–272. doi:10.1097/BSD.0b013e31812f6f54
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. doi:10.3171/2012.4.SPINE11255
Tsuzuki N, Abe R, Saiki K, Zhongshi L (1996) Extradural tethering effect as one mechanism of radiculopathy complicating posterior decompression of the cervical spinal cord. Spine 21(2):203–211
Hojo Y, Ito M, Abumi K, Kotani Y, Sudo H, Takahata M, Minami A (2011) A late neurological complication following posterior correction surgery of severe cervical kyphosis. Eur Spine J 20(6):890–898. doi:10.1007/s00586-010-1590-8
Suda K, Abumi K, Ito M, Shono Y, Kaneda K, Fujiya M (2003) Local kyphosis reduces surgical outcomes of expansive open-door laminoplasty for cervical spondylotic myelopathy. Spine 28(12):1258–1262. doi:10.1097/01.BRS.0000065487.82469.D9
Tanaka N, Nakanishi K, Fujiwara Y, Kamei N, Ochi M (2006) Postoperative segmental C5 palsy after cervical laminoplasty may occur without intraoperative nerve injury: a prospective study with transcranial electric motor-evoked potentials. Spine 31(26):3013–3017. doi:10.1097/01.brs.0000250303.17840.96
Barakat M, Hussein Y (2012) Anatomical study of the cervical nerve roots for posterior foraminotomy: cadaveric study. Eur Spine J 21(7):1383–1388. doi:10.1007/s00586-012-2158-6
Richman JD, Daniel TE, Anderson DD, Miller PL, Douglas RA (1995) Biomechanical evaluation of cervical spine stabilization methods using a porcine model. Spine 20(20):2192–2197
Singh K, Vaccaro AR, Kim J, Lorenz EP, Lim TH, An HS (2003) Biomechanical comparison of cervical spine reconstructive techniques after a multilevel corpectomy of the cervical spine. Spine 28(20):2352–2358. doi:10.1097/01.BRS.0000085344.22471.23 (discussion 2358)
Kawakami M, Tamaki T, Ando M, Yamada H, Yoshida M (2002) Relationships between sagittal alignment of the cervical spine and morphology of the spinal cord and clinical outcomes in patients with cervical spondylotic myelopathy treated with expansive laminoplasty. J Spinal Disord Techn 15(5):391–397
Vanichkachorn JS, Vaccaro AR, Silveri CP, Albert TJ (1998) Anterior junctional plate in the cervical spine. Spine 23(22):2462–2467
Epstein NE (2000) The value of anterior cervical plating in preventing vertebral fracture and graft extrusion after multilevel anterior cervical corpectomy with posterior wiring and fusion: indications, results, and complications. J Spinal Disord 13(1):9–15
Shou F, Li Z, Wang H, Yan C, Liu Q, Xiao C (2015) Prevalence of C5 nerve root palsy after cervical decompressive surgery: a meta-analysis. Eur spine J 24(12):2724–2734. doi:10.1007/s00586-015-4186-5
Kotani Y, Cunningham BW, Abumi K, McAfee PC (1994) Biomechanical analysis of cervical stabilization systems. An assessment of transpedicular screw fixation in the cervical spine. Spine 19(22):2529–2539
Kothe R, Ruther W, Schneider E, Linke B (2004) Biomechanical analysis of transpedicular screw fixation in the subaxial cervical spine. Spine 29(17):1869–1875
Komagata M, Nishiyama M, Endo K, Ikegami H, Tanaka S, Imakiire A (2004) Prophylaxis of C5 palsy after cervical expansive laminoplasty by bilateral partial foraminotomy. Spine J 4(6):650–655. doi:10.1016/j.spinee.2004.03.022
Ohashi M, Yamazaki A, Watanabe K, Katsumi K, Shoji H (2014) Two-year clinical and radiological outcomes of open-door cervical laminoplasty with prophylactic bilateral C4-C5 foraminotomy in a prospective study. Spine 39(9):721–727. doi:10.1097/BRS.0000000000000251
Sasai K, Saito T, Akagi S, Kato I, Ohnari H, Iida H (2003) Preventing C5 palsy after laminoplasty. Spine 28(17):1972–1977. doi:10.1097/01.BRS.0000083237.94535.46
Epstein NE, Hollingsworth R (2015) C5 Nerve root palsies following cervical spine surgery: a review. Surg Neurol Int 6(Suppl 4):S154–S163. doi:10.4103/2152-7806.156556
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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