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Cervical laminectomy of limited width prevents postoperative C5 palsy: a multivariate analysis of 263 muscle-preserving posterior decompression cases

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Abstract

Purpose

Between 2006 and 2010, we performed wide laminectomy (wide LAM) alone, with decompression performed between the bilateral medial margin of the zygapophyseal joints, or double-door laminoplasty (DL) combined with wide LAM for cervical compressive myelopathy (CCM). From 2010, instead of wide LAM and DL, we began to perform narrow LAM, where the laminectomy width was no more than 2–3 mm wider than the spinal cord width (SW). This study aimed to elucidate the risk factors for C5 palsy by reviewing surgical outcomes.

Methods

The clinical features and radiological findings of 263 CCM patients with or without C5 palsy were compared. Risk factors for C5 palsy were assessed using logistic regression analysis. The decompression width (DW) was defined as the laminectomy width or the width between the bilateral medial margins of the bony gutters in DL.

Results

Narrow LAM reduced the incidence of C5 palsy from 9.2 to 1.2%. DL was performed more frequently in the C5 palsy group. The difference between the DW and the SW (DW − SW) was significantly greater in the C5 palsy group. Posterior spinal cord shift, aging, and the number of consecutive laminae surgically treated were significantly higher in the C5 palsy group. The diameter of the foramen (DF) at C4/5 was significantly smaller in the C5 palsy patients. The logistic regression analysis revealed that DL, DW − SW, DF, and aging were risk factors for C5 palsy.

Conclusions

Cervical laminectomy of limited width prevented postoperative C5 palsy without compromising the functional recovery.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan

    Satoshi Nori, Ryoma Aoyama & Ken Ninomiya

  2. Department of Orthopedic Surgery, National Hospital Organization Murayama Medical Center, Tokyo, Japan

    Junichi Yamane

  3. Department of Orthopedic Surgery, Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan

    Kazuya Kitamura

  4. Department of Orthopedic Surgery, Kawasaki Municipal Hospital, Kanagawa, Japan

    Seiji Ueda

  5. Shiraishi Spine Clinic, 1-35-23, Sanno, Ota, Tokyo, 143-0023, Japan

    Tateru Shiraishi

Authors
  1. Satoshi Nori
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  2. Ryoma Aoyama
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  3. Ken Ninomiya
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  4. Junichi Yamane
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  5. Kazuya Kitamura
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  6. Seiji Ueda
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  7. Tateru Shiraishi
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Correspondence to Tateru Shiraishi.

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The authors have no conflict of interests to report concerning the materials or methods used in this study or the findings described in this paper.

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

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  • DOI: https://doi.org/10.1007/s00586-017-5202-8

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