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Can postoperative deltoid weakness after cervical laminoplasty be prevented by using intraoperative neurophysiological monitoring?

  • Muneharu Ando
  • Tetsuya Tamaki
  • Takuji Matsumoto
  • Kazuhiro Maio
  • Masatoshi Teraguchi
  • Noboru Takiguchi
  • Hiroki Iwahashi
  • Makiko Onishi
  • Yukihiro Nakagawa
  • Hiroshi Iwasaki
  • Shunji Tsutsui
  • Masanari Takami
  • Hiroshi Yamada
Original Research
  • 66 Downloads

Abstract

Laminoplasty, frequently performed in patients with cervical myelopathy, is safe and provides relatively good results. However, motor palsy of the upper extremities, which occurs after decompression surgery for cervical myelopathy, often reduces muscle strength of the deltoid muscle, mainly in the C5 myotome. The aim of this study was to investigate prospectively whether postoperative deltoid weakness (DW) can be predicted by performing intraoperative neurophysiological monitoring (IONM) during cervical laminoplasty and to clarify whether it is possible to prevent palsy using IONM. We evaluated the 278 consecutive patients (175 males and 103 females) who underwent French-door cervical laminoplasty for cervical myelopathy under IONM between November 2008 and December 2016 at our hospital. IONM was performed using muscle evoked potential after electrical stimulation to the brain [Br(E)-MsEP] from the deltoid muscle. Seven patients (2.5%) developed DW after surgery (2 with acute and 5 with delayed onset). In all patients, deltoid muscle strength recovered to ≥ 4 on manual muscle testing 3–6 months after surgery. Persistent IONM alerts occurred in 2 patients with acute-onset DW. To predict the acute onset of DW, Br(E)-MsEP alerts in the deltoid muscle had both a sensitivity and specificity of 100%. The PPV of persistent Br(E)-MsEP alerts had both a sensitivity and specificity of 100% for acute-onset DW. There was no change in Br(E)-MsEP in patients with delayed-onset palsy. The incidence of deltoid palsy was relatively low. Persistent Br(E)-MsEP alerts of the deltoid muscle had a 100% sensitivity and specificity for predicting a postoperative acute deficit. IONM was unable to predict delayed-onset DW. In only 1 patient were we able to prevent postoperative DW by performing a foraminotomy.

Keywords

Cervical laminoplasty Postoperative deltoid weakness Intraoperative neurophysiological monitoring Muscle evoked potential after electrical stimulation to the brain 

Notes

Compliance with ethical standards

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional committee (Wakayama Rosai Hospital ethics committee) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study. Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.

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Copyright information

© Springer Science+Business Media B.V., part of Springer Nature 2018

Authors and Affiliations

  • Muneharu Ando
    • 1
  • Tetsuya Tamaki
    • 2
  • Takuji Matsumoto
    • 3
  • Kazuhiro Maio
    • 1
  • Masatoshi Teraguchi
    • 4
  • Noboru Takiguchi
    • 5
  • Hiroki Iwahashi
    • 1
  • Makiko Onishi
    • 1
  • Yukihiro Nakagawa
    • 6
  • Hiroshi Iwasaki
    • 6
  • Shunji Tsutsui
    • 6
  • Masanari Takami
    • 6
  • Hiroshi Yamada
    • 6
  1. 1.Department of Orthopedic SurgeryWakayama Rosai HospitalWakayamaJapan
  2. 2.Aitoku Medical and Welfare CenterWakayamaJapan
  3. 3.Department of Orthopedic SurgeryNokami Kosei General HospitalNokami choJapan
  4. 4.Spine Care CenterWakayama Medical University Kihoku HospitalKatsuragi choJapan
  5. 5.Department of Emergency and Critical Care MedicineWakayama Medical UniversityWakayamaJapan
  6. 6.Department of Orthopedic SurgeryWakayama Medical UniversityWakayamaJapan

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