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Preoperative Risk Factors of C5 Nerve Root Palsy After Laminectomy and Fusion in Patients With Cervical Myelopathy: Analysis of 70 Consecutive Patients

Authors
 Kang Kyung-Chung  ;  Suk Kyung-Soo  ;  Kim Hak-Sun  ;  Moon Seong-Hwan  ;  Lee Hwan-Mo  ;  Seo Jung-Ho  ;  Kim Sung-Min  ;  Jin Sung-Yub  ;  Mella, Pierre 
Citation
 Clinical Spine Surgery, Vol.30(9) : 419-424, 2017 
Journal Title
 Clinical Spine Surgery 
ISSN
 2380-0186 
Issue Date
2017
Abstract
STUDY DESIGN: A retrospective study. OBJECTIVE: To identify preoperative risk factors causing cervical fifth nerve root palsy (C5 palsy) after laminectomy and fusion (LF). SUMMARY OF BACKGROUND DATA: It is well known that postoperative C5 palsy is not rare after cervical surgery. Although there remains controversy, C5 palsy is considered to be more common in patients who had LF than in those who had laminoplasty. However, the reason for the higher incidence of C5 palsy in patients with LF has been poorly understood. METHODS: A total of 70 consecutive patients (mean age: 60.3 y) who had LF due to cervical myelopathy were reviewed. Patients were divided on the basis of the presence (group P) or absence (group N) of C5 palsy. Among various risk factors for C5 palsy from previous reports, 6 risk factors were selected as follows: (1) preoperative low Japanese Orthopedic Association score, (2) postoperatively increased lordosis, (3) low Pavlov ratio, (4) high signal intensity in the cord at C3-C5, (5) anterior protruding mass lesion compressing the spinal cord, and (6) presence of C4-C5 foraminal stenosis. With these factors, the 2 groups were compared by statistical analysis. RESULTS: C5 palsy occurred in 10 patients (14.3%). The mean onset time was 3.5 days (range, 1-8 d) and the mean recovery time was 3.4 months (range, 1-7 mo). There were no significant differences in the preoperative Japanese Orthopedic Association score, cervical lordosis, Pavlov ratio, high signal intensity, and anterior protruding mass between the 2 groups (P>0.05). However, C4-C5 foraminal stenosis was found in 80.0% (8/10) in group P and 21.7% (13/60) in group N. There were significant differences between the 2 groups in C4-C5 foraminal stenosis (P=0.004). CONCLUSIONS: In this study, a high occurrence rate and risk factor for C5 palsy were verified after LF. Among the various factors, C4-C5 foraminal stenosis was the only risk factor for C5 palsy. Preoperative warning for C5 palsy after LF seems to be imperatively necessary, especially in patients with C4-C5 foraminal stenosis.
URI
http://ir.ymlib.yonsei.ac.kr/handle/22282913/161461
DOI
10.1097/BSD.0000000000000505
Appears in Collections:
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Orthopedic Surgery (정형외과학교실)
Yonsei Authors
김성민(Kim, Sung Min)
김학선(Kim, Hak Sun)
문성환(Moon, Seong Hwan)
서정호(Seo, Jung Ho)
석경수(Suk, Kyung Soo)
이환모(Lee, Hwan Mo)
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http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&AN=01933606-201711000-00007&LSLINK=80&D=ovft
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