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

Abstract

Introduction

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.

Objectives

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.

Methods

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.

Results

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.

Conclusions

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.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

References

  1. 1.

    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

    Article  Google Scholar 

  2. 2.

    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

    Article  Google Scholar 

  3. 3.

    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

    Article  Google Scholar 

  4. 4.

    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

    Article  Google Scholar 

  5. 5.

    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

    Article  Google Scholar 

  6. 6.

    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

    Article  Google Scholar 

  7. 7.

    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

    Article  Google Scholar 

  8. 8.

    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

    Article  Google Scholar 

  9. 9.

    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

    CAS  Article  Google Scholar 

  10. 10.

    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

    Article  Google Scholar 

  11. 11.

    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

    Article  Google Scholar 

  12. 12.

    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

    CAS  Article  Google Scholar 

  13. 13.

    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

    Article  Google Scholar 

  14. 14.

    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

    Article  Google Scholar 

  15. 15.

    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

    CAS  Article  Google Scholar 

  16. 16.

    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

    Article  Google Scholar 

Download references

Funding

No funds were received in support of this work.

Author information

Affiliations

Authors

Contributions

KT wrote and prepared the manuscript, and all of the authors participated in the study design. All authors have read, reviewed, and approved the article.

Corresponding author

Correspondence to Kazunari Takeuchi.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

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.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

Keywords

  • Cervical myelopathy
  • Cervical laminoplasty
  • C5 palsy
  • 10-s single-foot-tapping (FT) test
  • Cross-sectional area
  • Dura