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C4/5 foraminal stenosis predicts C5 palsy after expansive open-door laminoplasty

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Abstract

Introduction

Laminoplasty is frequently performed in cervical myelopathy patients, but can lead to unexpected postoperative C5 palsy. Although several studies have examined the pathogenesis and prevention of postoperative C5 palsy, many controversies remain and some radiological findings identified as risk factors were not correlated with our outcomes.

Purpose

This study sought reliable radiological findings that predict C5 palsy after laminoplasty and examined why the predictors of C5 palsy did not apply in our series.

Methods

This study reviewed 116 patients who underwent open-door laminoplasty for cervical spondylotic myelopathy between January 2014 and April 2016, retrospectively. C5 palsy was defined as weakness of the deltoid muscle. We evaluated the incidence of C5 palsy, the preoperative C2–7 Cobb’s angle, and Pavlov ratio at the C4/C5 level using simple cervical lateral radiographs. We also evaluated the existence of an ossified posterior longitudinal ligament, the transverse diameter of the C4/5 foramen, and increases in the anteroposterior diameter of the spinal canal at the C4/5 levels after surgery. Furthermore, a high signal intensity on T2-weighted images of the cervical spinal cord preoperatively was noted.

Results

Of the 116 patients, 16 cases were excluded and 100 cases were analyzed; postoperative C5 palsy occurred in 8 patients (8%). There were no significant differences between the two groups except the average diameter of the C4/5 foramen. A diameter of the C4/5 foramen of less than 2 mm was significantly related to C5 palsy in the binary logistic regression test.

Conclusions

A smaller diameter of the C4/5 foramen was the only factor significantly correlated with C5 palsy after laminoplasty. The results suggest that C4/5 foraminal stenosis is one of the best predictors of C5 palsy, which might be related to ischemic/reperfusion injury of the C5 root nerve after laminoplasty.

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References

  1. Chiba K, Ogawa Y, Ishii K et al (2006) Long-term results of expansive open-door laminoplasty for cervical myelopathy: average 14-year follow-up study. Spine 31:2998–3005

    Article  PubMed  Google Scholar 

  2. Hirabayashi K, Miyakawa J, Satomi K et al (1981) Operative results and postoperative progression of ossification among patients with ossification of cervical posterior longitudinal ligament. Spine 354–364

  3. Iwasaki M, Kawaguchi Y, Kimura T et al (2002) Long-term results of expansive laminoplasty for ossification of the posterior longitudinal ligament of the cervical spine: more than 10 years follow up. J Neurosurg 96:180–189

    PubMed  Google Scholar 

  4. Kurokawa T, Tsuyama N, Tanaka H (1982) Enlargement of spinal canal by the sagittal splitting of the spinous process. Bessatsu Seikeigeka 2:234–240

    Google Scholar 

  5. Seichi A, Takeshita K, Ohishi I et al (2001) Long-term results of double-door laminoplasty for cervical stenotic myelopathy. Spine 26:479–487

    Article  CAS  PubMed  Google Scholar 

  6. Chiba K, Toyama Y, Matsumoto M et al (2002) Segmental motor paralysis after expansive open-door laminoplasty. Spine 27:2108–2115

    Article  PubMed  Google Scholar 

  7. Fan D, Schwartz DM, Vaccaro AR et al (2002) Intraoperative neurophysiologic detection of iatrogenic C5 nerve root injury during laminectomy for cervical compression myelopathy. Spine 27:2499–2502

    Article  PubMed  Google Scholar 

  8. Hasegawa K, Homma T, Chiba Y (2007) Upper extremity palsy following cervical decompression surgery results from a transient spinal cord lesion. Spine 32:197–202

    Article  Google Scholar 

  9. Tsuzuki N, Abe R, Saiki K et al (1996) Extradural tethering effect as one mechanism of radiculopathy complicating posterior decompression of the cervical spinal cord. Spine 21:203–211

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  11. Hirabayashi K, Satomi K (1988) Operative procedure and results of expansive open-door laminoplasty. Spine 13:870–876

    Article  CAS  PubMed  Google Scholar 

  12. Matsunaga H, Inada M, Takeuchi M et al (2007) Pathogenesis and prevention of C5 palsy after cervical laminoplasty [in Japanese]. Chubu Jpn Orthop Trauma Surg 50:135–136 (in Japanese)

    Google Scholar 

  13. Geets X, Daisne JF, Arcangeli S et al (2006) Inter-observer variability in the delineation of pharyngo-laryngeal tumor, parotid glands and cervical spinal cord: comparison between CT-scan and MRI. Radiother Oncol 77(1):25–31

    Article  Google Scholar 

  14. Speciale AC, Pietrobon R, Urban CW et al (2002) Observer variability in assessing lumbar spinal stenosis severity on magnetic resonance imaging and its relation to cross-sectional spinal canal area. Spine 27:1082–1086

    Article  PubMed  Google Scholar 

  15. Kuijper B, Beelen A, van der Kallen BF et al (2011) Interobserver agreement on MRI evaluation of patients with cervical radiculopathy. Clin Radiol 66:25–29

    Article  CAS  PubMed  Google Scholar 

  16. Katsumi K, Yamazaki A, Watanabe K et al (2013) Analysis of C5 palsy after cervical open-door laminoplasty: relationship between C5 palsy and foraminal stenosis. J Spinal Disord Tech 26:177–182

    Article  PubMed  Google Scholar 

  17. Wu FL, Sun Y, Pan SF et al (2014) Risk factors associated with upper extremity palsy after expansive open-door laminoplasty for cervical myelopathy. Spine J 14:909–915

    Article  PubMed  Google Scholar 

  18. Imagama S, Matsuyama Y, Yukawa Y et al (2010) C5 palsy after cervical laminoplasty. J Bone Joint Surg [Br] 92B:393–400

    Article  Google Scholar 

  19. Kurakawa T, Miyamoto H, Kaneyama S et al (2016) C5 nerve palsy after posterior reconstruction surgery: predictive risk factors of the incidence and critical range of correction for kyphosis. Eur Spine J 25(7):2060–2067

    Article  PubMed  Google Scholar 

  20. Lubelski D, Derakhshan A, Nowacki AS et al (2014) Predicting C5 palsy via the use of preoperative anatomic measurements. Spine J 14(9):1895–1901

    Article  PubMed  Google Scholar 

  21. Planchard RF, Maloney PR, Mallory GW et al (2016) Postoperative Delayed Cervical Palsies: Understanding the Etiology. Global Spine J 6(6):571–583

    Article  PubMed  PubMed Central  Google Scholar 

  22. Katsumi K, Yamazaki A, Watanabe K et al (2012) Can prophylactic bilateral C4/C5 foraminotomy prevent postoperative C5 palsy after open-door laminoplasty?: a prospective study. Spine 37(9):748–754

    Article  PubMed  Google Scholar 

  23. Planchard RF, Maloney PR, Mallory GW et al (2016) Postoperative Delayed Cervical Palsies: Understanding the Etiology. Global Spine J 6(6):571–583

    Article  PubMed  PubMed Central  Google Scholar 

  24. Sakaura H, Hosono N, Mukai Y et al (2003) C5 palsy after decompression surgery for cervical myelopathy: review of the literature. Spine 28:2447–2451

    Article  PubMed  Google Scholar 

  25. Rydevik B, Brown MD, Lundborg G (1984) Pathoanatomy and pathophysiology of nerve root compression. Spine 9:7–15

    Article  CAS  PubMed  Google Scholar 

  26. Bagdatoglu C, Saray A, Surucu HS et al (2002) Effect of trapidil in ischemia/reperfusion injury of peripheral nerves. Neurosurg 51:212–220

    Article  Google Scholar 

  27. Saray A, Can B, Akbiyik F et al (1999) Ischaemia-reperfusion injury of the peripheral nerve: an experimental study. Microsurg 19:374–380

    Article  CAS  Google Scholar 

  28. Sasai K, Saito T, Akagi S et al (2003) Preventing C5 nerve palsy after laminoplasty. Spine 28:1972–1977

    Article  PubMed  Google Scholar 

  29. Yonenobu K, Hosono N, Iwasaki M et al (1991) Neurologic complications of surgery for cervical compression myelopathy. Spine 16:1277–1282

    Article  CAS  PubMed  Google Scholar 

  30. Tsuzuki N, Abe R, Saiki K et al (1993) Paralysis of the arm after posterior decompression of the cervical spinal cord II: analyses of clinical findings. Eur Spine J 2:197–202

    Article  CAS  PubMed  Google Scholar 

  31. Sodeyama T, Goto S, Mochizuki M et al (1999) Effect of decompression enlargement laminoplasty for posterior shifting of the spinal cord. Spine 24:1527–1531

    Article  CAS  PubMed  Google Scholar 

  32. Hatta Y, Shiraishi T, Hase H et al (2005) Is posterior spinal cord shifting by extensive posterior decompression clinically significant for multisegmental cervical spondylotic myelopathy? Spine 30:2414–2419

    Article  PubMed  Google Scholar 

  33. Shiozaki T, Otsuka H, Nakata Y et al (2009) Spinal cord shift on magnetic resonance imaging at 24 h after cervical laminoplasty. Spine 34:274–279

    Article  PubMed  Google Scholar 

  34. Kaneyama S, Sumi M, Kanatani T et al (2010) Prospective study and multivariate analysis of the incidence of C5 palsy after cervical laminoplasty. Spine 35:E1553–E1558

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Chungnam National University School of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea

    Ho-jin Lee, Jae-sung Ahn, Byungkon Shin & Hoseok Lee

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  1. Ho-jin Lee
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  2. Jae-sung Ahn
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  3. Byungkon Shin
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  4. Hoseok Lee
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Correspondence to Jae-sung Ahn.

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No funding, either internal or external, was used to produce this manuscript.

Conflict of interest

All the authors declare they have no competing of interests.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Lee, Hj., Ahn, Js., Shin, B. et al. C4/5 foraminal stenosis predicts C5 palsy after expansive open-door laminoplasty. Eur Spine J 26, 2340–2347 (2017). https://doi.org/10.1007/s00586-017-5077-8

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  • DOI: https://doi.org/10.1007/s00586-017-5077-8

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