The smaller cross-sectional areas of the dural sacs in patients without C5 palsy after posterior cervical spine surgery may lead to less neurological improvement.
The aim of this retrospective study was to clarify the differences in the cross-sectional area of the dural sac in the cervical spine and neurological improvement in patients with and without C5 palsy after posterior cervical spinal surgery.
We retrospectively evaluated the postoperative cross-sectional areas of the dural sacs and neurological outcomes in patients with and without C5 palsy after posterior cervical spine surgery. We compared the postoperative cross-sectional areas of the dural sac at C4/5 and C5/6 on magnetic resonance images between the C5 palsy group (n = 19) and the no-C5 palsy group (n = 84) after posterior cervical spinal surgery 1 year postoperatively. Performance tests, namely, the 10-s grip-and-release test and the 10-s single-foot-tapping (FT) test, were compared between the two groups.
Postoperative cross-sectional areas of the dural sac at C4/5 and C5/6 (233.3 mm2 and 226.6 mm2, respectively) in the C5 palsy group were significantly larger (P = 0.0036 and P = 0.0039, respectively) than those (195.0 mm2 and 193.8 mm2, respectively) in the no-C5 palsy group. Postoperative gain in the grip-and-release test was similar between the two groups. Postoperative gain in the FT test (4.9 times) in the C5 palsy group was significantly larger (P = 0.0060) than that (1.8 times) in the no-C5 palsy group.
In the C5 palsy group 1 year after posterior cervical spine surgery, the cross-sectional areas of the dural sac were larger, and the 10-s single FT test improved noticeably.
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Shiozaki T, Otsuka H, Nakata Y, Yokoyama T, Takeuchi K, Ono A, Numasawa T, Wada K, Toh S (2009) Spinal cord shift on magnetic resonance imaging at 24 hours after cervical laminoplasty. Spine 34:274–279. https://doi.org/10.1097/BRS.0b013e318194e275
Nakashima H, Imagama S, Yukawa Y, Kaneyama 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 after cervical posterior fusion with instrumentation. J Neurosurg Spine 17:103–110. https://doi.org/10.3171/2012.4.SPINE11255
Bydon M, Macki M, Aygun N, Sciubba DM, Wolinsky JP, Witham TF, Gokaslan ZL, Byoden A (2014) Development of postoperative C5 palsy is associated with wider posterior decompression: an analysis of 41 patients. Spine J 14:2861–2867. https://doi.org/10.1016/j.spinen.2014.03.040
Baba S, Ikuta K, Ikeuchi H, Shiraki H, Komiya N, Kitamura T, Senba H, Shidahara S (2016) Risk factor analysis for C5 palsy after double-door laminoplasty for cervical spondylotic myelopathy. Asian Spine J 10:298–308. https://doi.org/10.4184/asj.2016.10.2.298
Lim CH, Roh SW, Rhim SC, Jeon SR (2017) Clinical analysis of C5 palsy after cervical decompression surgery: relationship between recovery duration and clinical and radiological factors. Eur Spine J 26:1101–1110. https://doi.org/10.1007/s00586-016-4664-4
Nori S, Aoyama R, Ninomiya K, Yamane J, Kitamura K, Ueda S, Shiraishi T (2017) Cervical laminoplasty of limited width prevents postoperative C5 palsy: a multivariate analysis of 263 muscle-preserving posterior decompression cases. Eur Spine J 26:2393–2403. https://doi.org/10.1007/s00586-017-5202-8
Takeuchi K, Yokoyama T, Numasawa T, Yamasaki Y, Kudo H, Itabashi T, Chin S, Wada K (2016) K-line (–) in the neck-flexed position in patients with ossification of the posterior longitudinal ligament is a risk factor for poor clinical outcome after cervical laminoplasty. Spine 41:1891–1895. https://doi.org/10.1097/BRS.0000000000001660
Takeuchi K, Yokoyama T, Aburakawa S, Saito A, Numasawa T, Iwasaki T, Okada A, Ito J, Ueyama K, Toh S (2005) Axial symptoms after cervical laminoplasty with C3 laminectomy compared with conventional C3–C7 laminoplasty. A modified laminoplasty preserving the semispinalis cervicis inserted into axis. Spine 30:2544–2549. https://doi.org/10.1097/01.brs.0000186331.66490.ba
Nakano K, Harata S, Suetsuna F, Araki T, Itoh J (1992) Spinous process-splitting laminoplasty using hydroxyapatite spinous process spacer. Spine 17(3 Suppl):S41–43. https://doi.org/10.1097/00007632-199203001-00009
Takeuchi K, Yokoyama T, Numasawa T, Itabashi T, Yamasaki Y, Kudo H (2018) A novel posterior approach preserving three muscles inserted at C2 in multilevel cervical posterior decompression and fusion using C2 pedicle screws. Eur Spine J 27:1349–1357. https://doi.org/10.1007/s00586-017-5402-2
Takeuchi K, Yokoyama T, Wada K, Kudo H (2019) Relationship between enlargement of the cross-sectional area of the dural sac and neurological improvements after cervical laminoplasty: differences between cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament. Spine Surg Relat Res 3:27–36. https://doi.org/10.22603/ssrr.2018-0008
Ono K, Ebara S, Fujii T, Yonenobu K, Fujiwara K, Yamashita K (1987) Myelopathy hand. New clinical sign of cervical cord damage. J Bone Joint Surg Br 69:215–219
Numasawa T, Ono A, Wada K, Yamasaki Y, Yokoyama T, Aburakawa S, Takeuchi K, Kumagai G, Kudo H, Umeda T, Nakaji S, Toh S (2012) Simple foot tapping test as a quantitative objective assessment of cervical myelopathy. Spine 37:108–113. https://doi.org/10.1097/BRS.0b013e31821041f8
Enoki H, Tani T, Ishida K (2019) Foot tapping test as part of routine neurologic examination in degenerative compression myelopathies: a significant correlation between 10-s foot tapping speed and 30-m walking speed. Spine Surg Relat Res 3:207–213. https://doi.org/10.22603/ssrr.2018-0033
Uematsu Y, Tokuhashi Y, Matsuzaki H (1998) Radiculopathy after laminoplasty of the cervical spine. Spine 23:2057–2062. https://doi.org/10.1097/00007632-199810010-00004
Tsuji T, Matsumoto M, Nakamura M, Ishi K, Fujita N, Chiba K, Watanabe K (2017) Factors associated with postoperative C5 palsy after expansive open-door laminoplasty: retrospective cohort study using multivariable analysis. Eur Spine J 26:2410–2416. https://doi.org/10.1007/s00586-017-5223-3
No funds were received in support of this work.
Conflict of interest
The authors declare that they have no conflict of interest.
This study was approved by the institutional ethics committee of Odate Municipal General Hospital (Approval No. 30-09), and informed consent was obtained from all participants.
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Takeuchi, K., Yokoyama, T., Wada, K. et al. Improvement in the results of the simple-foot-tapping test and cross-sectional area of the dural sac in patients with C5 palsy after posterior cervical spine surgery. Eur J Orthop Surg Traumatol (2020). https://doi.org/10.1007/s00590-020-02715-1
- Cervical myelopathy
- Cervical laminoplasty
- C5 palsy
- 10-s single-foot-tapping (FT) test
- Cross-sectional area