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The Use of Preoperative and Intraoperative Pavlov Ratio to Predict the Risk of Postoperative C5 Palsy after Expansive Open-Door Laminoplasty for Cervical Myelopathy

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Abstract

Background

No standard preoperative preventive measure has been established to decrease the occurrence of C5 palsy after expansive open-door laminoplasty. The aim of this study is to establish a reliable measured parameter in predicting the risk of the postoperative C5 palsy.

Materials and Methods

A total of 276 patients receiving posterior open-door laminoplasty for cervical spinal stenotic myelopathy were studied. The patients were divided into two groups according to the preoperative Pavlov ratio (Group A: Pavlov ratio <0.65 and Group B: Pavlov ratio ≥0.65). Correlations between the occurrence of postoperative C5 palsy and Pavlov ratio were analyzed, and Group A was further tested. The surgical procedures, clinical symptoms, and Pavlov ratio were described.

Results

The patients with Pavlov ratio <0.65 had a higher risk of developing postoperative C5 palsy (P < 0.05, odds ratio [OR] = 2.91). No significant difference was found in gender, age, etiology, type of operation, and pre- and postoperative Japanese Orthopaedic Association scores between patients with and without postoperative C5 palsy. The cutoff (1.01) of receiver operating characteristic curve of the postoperative Pavlov ratio of the Group A was calculated. The postoperative Pavlov ratio ≥1.01 of the patients in Group A was a significant risk factor of the development of postoperative C5 palsy (P < 0.01, OR = 10.83).

Conclusions

The preoperative Pavlov ratio <0.65 at the C5 level was more likely to develop the postoperative C5 palsy. When the preoperative Pavlov ratio is <0.65, the postoperative Pavlov ratio ≥1.01 at the C5 level is a reliable predictor for the development of postoperative C5 palsy. Pavlov ratio may be one of the reasons for postoperative C5 palsy.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China

    Weifang Liu

  2. Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China

    Bingjin Wang, Zengwu Shao &  Xianlin Zeng

Authors
  1. Bingjin Wang
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  2. Weifang Liu
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  3. Zengwu Shao
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  4. Xianlin Zeng
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Correspondence to Xianlin Zeng.

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Wang, B., Liu, W., Shao, Z. et al. The Use of Preoperative and Intraoperative Pavlov Ratio to Predict the Risk of Postoperative C5 Palsy after Expansive Open-Door Laminoplasty for Cervical Myelopathy. JOIO 53, 309–314 (2019). https://doi.org/10.4103/ortho.IJOrtho_217_17

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  • DOI: https://doi.org/10.4103/ortho.IJOrtho_217_17

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