scholarly journals Analysis of risk factors for C5 nerve root paralysis after posterior cervical decompression

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Bo Liu ◽  
Yanchen Chu ◽  
Jinfeng Ma ◽  
Xiaojie Tang ◽  
Junpeng Pan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Spinal Cord ◽  
Cervical Spine ◽  
Nerve Root ◽  
Posterior Longitudinal Ligament ◽  
Spine Curvature ◽  
Independent Risk Factors ◽  
T2 Hyperintensity ◽  
Intervertebral Foramina ◽  
Posterior Longitudinal Ligament Ossification

Abstract Background C5 nerve root paralysis is a nonnegligible complication after posterior cervical spine surgery (PCSS). The cause of its occurrence remains controversial. The purpose of this study was to analyse the incidence of and risk factors for C5 nerve root paralysis after posterior cervical decompression. Methods We retrospectively analysed the clinical data of 640 patients who underwent PCSS in the Department of Orthopaedics, Affiliated Hospital of Qingdao University from September 2013 to September 2019. According to the status of C5 nerve root paralysis after surgery, all patients were divided into paralysis and normal groups. Univariate and multivariate analyses were used to determine the independent risk factors for C5 nerve root paralysis. A receiver operating characteristic (ROC) curve was used to demonstrate the discrimination of all independent risk factors. Results Multivariate logistic regression analysis revealed that male sex, preoperative cervical spine curvature, posterior longitudinal ligament ossification, and preoperative C4/5 spinal cord hyperintensity were independent risk factors for paralysis, whereas the width of the intervertebral foramina was an independent protective factor for paralysis. The area under the curve (AUC) values of the T2 signal change at C4-C5, sex, cervical foramina width, curvature and posterior longitudinal ligament ossification were 0.706, 0.633, 0.617, 0.637, and 0.569, respectively. Conclusions Male patients with C4-C5 intervertebral foramina stenosis, preoperative C4-C5 spinal cord T2 high signal, combined with OPLL, and higher preoperative cervical spine curvature are more likely to develop C5 nerve root paralysis after surgery. Among the above five risk factors, T2 hyperintensity change in C4-C5 exhibits the highest correlation with C5 paralysis and strong diagnostic power. It seems necessary to inform patients who have had cervical spine T2 hyperintensity before surgery of C5 nerve root paralysis after surgery, especially those with altered spinal cord T2 signals in the C4-C5 segment.

Biomechanical Effects on Cervical Spinal Cord and Nerve Root Following Laminoplasty for Ossification of the Posterior Longitudinal Ligament in the Cervical Spine: A Comparison Between Open-Door and Double-Door Laminoplasty Using Finite Element Analysis

2018 ◽  
Vol 140 (7) ◽  
Author(s):  
Batbayar Khuyagbaatar ◽  
Kyungsoo Kim ◽  
Tserenchimed Purevsuren ◽  
Sang-Hun Lee ◽  
Yoon Hyuk Kim
Keyword(s):  
Spinal Cord ◽  
Finite Element ◽  
Cervical Spine ◽  
Nerve Root ◽  
Cervical Spinal Cord ◽  
Posterior Longitudinal Ligament ◽  
Cord Compression ◽  
Open Door ◽  
Nerve Roots ◽  
Posterior Shift

Many clinical case series have reported the predisposing factors for C5 palsy and have presented comparisons of the two types of laminoplasty. However, there have been no biomechanical studies focusing on cervical spinal cord and nerve root following laminoplasty. The purpose of this study is to investigate biomechanical changes in the spinal cord and nerve roots following the two most common types of laminoplasty, open-door and double-door laminoplasty, for cervical ossification of the posterior longitudinal ligament (OPLL). A finite element (FE) model of the cervical spine and spinal cord with nerve root complex structures was developed. Stress changes in the spinal cord and nerve roots, posterior shift of the spinal cord, and displacement of the cervical nerve roots were analyzed with two types of cervical laminoplasty models for variations in the degree of canal occupying ratio and shape of the OPLL. The shape and degree of spinal cord compression caused by the OPLL had more influence on the changes in stress, posterior shift of the spinal cord, and displacement of the nerve root than the type of laminoplasty. The lateral-type OPLL resulted in imbalanced stress on the nerve roots and the highest nerve root displacement. Type of laminoplasty and shape and degree of spinal cord compression caused by OPLL were found to influence the changes in stress and posterior displacement of the cervical spinal cord and nerve roots. Lateral-type OPLL might contribute to the development of C5 palsy due to the imbalanced stress and tension on the nerve roots after laminoplasty.

Evaluation of Cervical Spine Surgery by Postoperative Myelography

Neurosurgery ◽  
1983 ◽  
Vol 12 (4) ◽  
pp. 416-421 ◽  
Author(s):  
Charles A. Fager
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Nerve Root ◽  
Spontaneous Remission ◽  
Cord Compression ◽  
Cervical Disc ◽  
Nerve Root Compression ◽  
Cervical Fusion ◽  
Cervical Spine Surgery ◽  
Cervical Spine Fusion

Abstract After spontaneous remission of nerve root compression, a myelographic defect may persist. Similarly, myelopathy may remain nonprogressive for long periods despite appreciable myelographic deformity. Although operation may arrest or improve the symptoms of cervical disc lesions and spondylosis, the ultimate confirmation that entrapped neural elements have been relieved permanently can only be provided by postoperative myelography. Preoperative and postoperative myelography documents the significant improvement that can be achieved by using posterolateral and posterior approaches to the cervical spine in patients with nerve root or spinal cord compression. The results in this group of patients were achieved with none of the disadvantages or complications of cervical spine fusion or of the interbody removal of cervical disc tissue, also leading to cervical fusion.

scholarly journals P.091 Anterior surgical fixation for cervical spine flexion-distraction injuries

2017 ◽  
Vol 44 (S2) ◽  
pp. S36-S37
Author(s):  
AS Jack ◽  
G Choy ◽  
G Hardy St-Pierre ◽  
R Fox ◽  
A Nataraj
Keyword(s):  
Risk Factors ◽  
Cervical Spine ◽  
Failure Criteria ◽  
Posterior Fixation ◽  
Cervical Spine Injuries ◽  
Failure Data ◽  
Number Of Patients ◽  
Surgical Fixation ◽  
Independent Risk Factors ◽  
Anterior Posterior

Background: Optimal surgical management for flexion--distraction cervical spine injuries remains controversial with anterior, posterior, and circumferential fixation being accepted. Here, we examined risk factors for clinical and radiographic failure in patients with one segment cervical flexion-distraction injuries having undergone anterior surgical fixation. Methods: A retrospective review of 57 consecutive patients undergoing anterior fixation for cervical flexion-distraction injuries between 2008-2012 was performed. The primary outcome was the number of patients requiring additional surgical stabilization and/or radiographic failure. Data collected inlcuded age, gender, mechanism and level of injury, facet pattern injury, and vertebral endplate fracture. Results: Six patients failed clinically and/or radiographically (11%). Four patients (7%) required additional posterior fixation. Two patients identified met radiographic failure criteria, however had fused radiographically, were stable clinically, and no further treatment was pursued. Progressive kyphosis and translation correlated with need for revision (p<0.05 and p=0.02, respectively). No differences were identified for all other clinical and radiological factors assessed. Conclusions: This study supports the growing body of evidence for anterior fixation alone for flexion-distraction injuries. Findings suggest that measurements including segmental translation and kyphosis may predict radiographic failure and need for further surgical stabilization in some patients. Assessment for independent risk factors for anterior approach failure with a validated predictive scoring model should be considered.

Utility of modified transarticular screw in the middle and lower cervical spine as intermediate fixation in posterior long fusion surgery

2009 ◽  
Vol 11 (5) ◽  
pp. 555-561 ◽  
Author(s):  
Hiroshi Miyamoto ◽  
Masatoshi Sumi ◽  
Koki Uno
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Cobb Angle ◽  
Nerve Root ◽  
Japanese Orthopaedic Association ◽  
Transarticular Screw ◽  
Fusion Surgery ◽  
Nerve Root Injury ◽  
A New Technique

Object The use of a pedicle screw (PS) in the cervical spine ensures strong fixation. However, 6.7–29% of such screws appear to be malpositioned using manual insertion techniques, especially at C-3 to C-6 where the pedicle diameter is smaller, potentially causing catastrophic complications such as vertebral artery (VA) and spinal cord or nerve root injuries. To optimize safety, the authors use a new technique: cephalad and/or caudad ends at C-2 and C-7/T-1, respectively, are fixed with PSs, and intermediate points around C3–6 are fixed using a modified transarticular screw technique that captures 3 dorsal cortices and preserves the ventral cortex of the facet in posterior long fusion surgery involving occipitospinal fixation. The purpose of the present study was to demonstrate this technique and evaluate the clinical and radiological outcomes. Methods Thirty-nine patients, 8 men and 31 women, with a mean age of 61.7 ± 11.0 years at surgery, were included in the study. Twenty-eight occipitospinal fusions and 11 posterior long fusions were performed. Patients were divided into 2 groups: a rheumatoid arthritis (RA) group consisting of 26 patients and a non-RA group of 13 patients including 7 with athetoid cerebral palsy. Clinical outcomes were evaluated according to the Japanese Orthopaedic Association (JOA) score. For radiological evaluation, the Cobb angle on lateral radiographs was measured preoperatively, postoperatively, and at the final follow-up, and the degree of realignment from pre- to postoperation and the loss of correction from postoperation to the follow-up were compared between the 2 patient groups. Results The recovery rate of the JOA score was 50.6 ± 20.7% in the RA group and 37.3 ± 24.3% in the non-RA group. Neither VA injury nor spinal cord or nerve root injury occurred among this series. The degree of realignment was greater in the non-RA group (9.2 ± 13.9°) than the RA group (1.4 ± 12.7°) as the Cobb angle was more kyphotic preoperatively in the non-RA group (2.9 ± 18.6°) than in the RA group (17.4 ± 15.7°). However, 38.5% of patients in the non-RA group had a correction loss > 10% compared with 7.7% in the RA group; this difference was statistically significant. Conclusions The featured transarticular screw technique, which preserves the ventral cortex of the facet, as intermediate fixation in long fusion is a safe and easy procedure with few complications. It ensures acceptable clinical and radiological outcomes, especially in patients with RA.

Recovery of Nerve Root Function after Complete Quadriplegia from Cervical Spine Fractures

Neurosurgery ◽  
1986 ◽  
Vol 19 (5) ◽  
pp. 809-812 ◽  
Author(s):  
C. Benzel Edward ◽  
J. Larson Sanford
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Nerve Root ◽  
Root Function ◽  
Spine Fractures ◽  
Anterior Decompression ◽  
Cord Injury ◽  
Nerve Root Decompression ◽  
Anterior Decompression And Fusion ◽  
Cervical Spine Fractures

Abstract Thirty-five patients with complete myelopathies secondary to cervical spine fractures from C-4 to C-7 underwent spinal decompressions and fusions between 1975 and 1981. Twenty-five of these patients underwent simultaneous nerve root decompressions, 23 with an accompanying anterior decompression and fusion and 2 with an accompanying posterior fusion. Substantial recovery of nerve root function occurred in 15 of these patients. A posterior reduction and fusion without nerve root decompression was performed in each of the remaining 10 patients. None of these patients demonstrated a significant improvement neurologically. Operation for nerve root decompression is indicated in selected victims of spinal cord injury.

Laminectomy and Posterior Cervical Plating for Multilevel Cervical Spondylotic Myelopathy and Ossification of the Posterior Longitudinal Ligament: Effects on Cervical Alignment, Spinal Cord Compression, and Neurological Outcome

Neurosurgery ◽  
2003 ◽  
Vol 52 (5) ◽  
pp. 1081-1088 ◽  
Author(s):  
John K. Houten ◽  
Paul R. Cooper
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Neurological Outcome ◽  
Cervical Spondylotic Myelopathy ◽  
Posterior Longitudinal Ligament ◽  
X Rays ◽  
Lateral Mass ◽  
Japanese Orthopedic Association ◽  
Curvature Index ◽  
Muscle Groups

Abstract OBJECTIVE Multilevel anterior decompressive procedures for cervical spondylotic myelopathy or ossification of the posterior longitudinal ligament may be associated with a high incidence of neurological morbidity, construct failure, and pseudoarthrosis. We theorized that laminectomy and stabilization of the cervical spine with lateral mass plates would obviate the disadvantages of anterior decompression, prevent the development of kyphotic deformity frequently seen after uninstrumented laminectomy, decompress the spinal cord, and produce neurological results equal or superior to those achieved by multilevel anterior procedures. METHODS We retrospectively reviewed the records of 38 patients who underwent laminectomy and lateral mass plating for cervical spondylotic myelopathy or ossification of the posterior longitudinal ligament between January 1994 and November 2001. Seventy-six percent of patients had spondylosis, 18% had ossification of the posterior longitudinal ligament, and 5% had both. Clinical presentation included upper extremity sensory complaints (89%), gait difficulty (70%), and hand use deterioration (67%). Spasticity was present in 83%, and weakness of one or more muscle groups was seen in 79%. Spinal cord signal abnormality on sagittal T2-weighted magnetic resonance imaging (MRI) was seen in 68%. Neurological evaluation was performed using a modification of the Japanese Orthopedic Association Scale for functional assessment of myelopathy, the Cooper Scale for separate evaluation of upper and lower extremity motor function, and a five-point scale for evaluation of strength in individual muscle groups. Lateral cervical spine x-rays were analyzed using a curvature index to determine maintenance of alignment. Each surgically decompressed level was graded on a four-point scale using axial MRI to assess the adequacy of decompression. Late follow-up was conducted by telephone interview. RESULTS Laminectomy was performed at a mean 4.6 levels. Follow-up was obtained at a mean of 30.2 months after the procedure. The score on the modified Japanese Orthopedic Association scale improved in 97% of patients from a mean of 12.9 preoperatively to 15.58 postoperatively (P&lt; 0.0001). In the upper extremities, function measured by the Cooper Scale improved from 1.8 to 0.7 (P&lt; 0.0001), and in the lower extremities, function improved from 1.0 to 0.4 (P&lt; 0.0002). There was a statistically significant improvement in strength in the triceps (P&lt; 0.0001), iliopsoas (P&lt; 0.0002), and hand intrinsic muscles (P&lt; 0.0001). X-rays obtained at a mean of 5.9 months after surgery revealed no change in spinal alignment as measured by the curvature index. There was a decrease in the mean preoperative compression grade from 2.46 preoperatively to 0.16 postoperatively (P&lt; 0.0001). There was no correlation between neurological outcome and the presence of spinal cord signal change on T2-weighted MRI scans, patient age, duration of symptoms, or preoperative medical comorbidity. CONCLUSION Multilevel laminectomy and instrumentation with lateral mass plates is associated with minimal morbidity, provides excellent decompression of the spinal cord (as visualized on MRI), produces immediate stability of the cervical spine, prevents kyphotic deformity, and precludes further development of spondylosis at fused levels. Neurological outcome is equal or superior to multilevel anterior procedures and prevents spinal deformity associated with laminoplasty or noninstrumented laminectomy.

scholarly journals Analysis of myelomalacia and posterior longitudinal Ligament ossification as prognostic factors in patients with cervical spondylotic myelopathy submitted to laminoplasty

2021 ◽  
Vol 32 (2) ◽  
pp. 297-301
Author(s):  
Desirée Elizabeth Pasqualetto Antikievicz ◽  
Giulio Bartié Rossi ◽  
Marcos Vinicius Calfatt Maldaun ◽  
Paulo Henrique Pires de Aguiar ◽  
Daniel Gripp ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Prognostic Factors ◽  
Cervical Spondylotic Myelopathy ◽  
Cervical Spinal Cord ◽  
Posterior Longitudinal Ligament ◽  
The Elderly ◽  
Cervical Canal ◽  
Open Door ◽  
Cord Injury ◽  
Posterior Longitudinal Ligament Ossification

Background: Cervical spondylotic myelopathy is a degenerative disease of the intervertebral disc and vertebral body of the spine that causes cervical spinal cord injury due to central vertebral canal stenosis. Its prevalence is higher in the elderly. Treatment is usually surgical when the spinal cord is affected either clinically with pyramidal release or radiologically with the altered spinal cord. Objective: The rationale of this study is to analyze the myelomalacia and the ossification of posterior longitudinal ligament as prognostic factors in the postoperative evolution of patients with cervical canal compression who underwent laminoplasty by open-door or french-door techniques. Methods: We performed a retrospective analysis of 18 surgical cases of spondylotic cervical myelopathy of the same senior neurosurgeon, using the chi-square test to analyze prognostic factors for patients’ postoperative evolution in the Nurick scale, after open-door or french-door laminoplasty. Results: The comparison between pre and postoperative showed an improvement of 71.43% of cases that did not have ligament ossification compared to 45.45% of cases that presented posterior longitudinal ligament ossification. Also, there was a better prognosis in patients without myelomalacia, as 71.43% of them improved their condition against only 45.45% improvement in those with myelomalacia. Conclusion: There is a need for further studies with larger samples to expressively prove that the presence of longitudinal ligament ossification and the previous presence of myelomalacia are factors of worse prognosis in the postoperative evolution of patients with cervical spondylotic myelopathy submitted to laminoplasty.

Transthoracic microsurgical anterior decompression without fusion for ossification of the posterior longitudinal ligament in the thoracic spine

2020 ◽  
Vol 33 (6) ◽  
pp. 757-765
Author(s):  
Seokjin Ko ◽  
Junseok Bae ◽  
Sang-Ho Lee
Keyword(s):  
Risk Factors ◽  
Recovery Rate ◽  
Japanese Orthopaedic Association ◽  
Postoperative Outcome ◽  
Posterior Longitudinal Ligament ◽  
Anterior Decompression ◽  
Kyphotic Angle ◽  
Csf Leakage ◽  
Independent Risk Factors ◽  
The Mean

OBJECTIVEThe authors aimed to analyze outcomes following transthoracic microsurgical anterior decompression of thoracic ossification of the posterior longitudinal ligament (T-OPLL), which was causing myelopathy, and determine the predictive factors for surgical outcomes.METHODSPatients who underwent transthoracic microsurgical anterior decompression without fusion for the treatment of T-OPLL from December 2014 to May 2019 were included. Demographic, radiological, and perioperative data and clinical outcomes of 35 patients were analyzed. The modified Japanese Orthopaedic Association (mJOA) score and recovery rate were used to evaluate functional outcomes.RESULTSA total of 35 consecutive patients (8 men and 27 women; mean age 52.2 ± 10.8 years) were enrolled in this study, and the mean follow-up period was 65.5 ± 51.9 months. The mean mJOA score significantly improved after surgery (5.9 ± 1.8 vs 8.3 ± 1.5, p < 0.001), with a mean recovery rate of 47.7% ± 24.5%. The visual analog scale (VAS) score significantly improved after surgery (7.3 ± 1.3 vs 4.3 ± 0.7, p < 0.001). The outcome was excellent in 4 patients (11.4%), good in 21 patients (60.0%), fair in 4 patients (11.4%), unchanged in 5 patients (14.3%), and worsened in 1 patient (2.9%). There were 12 cases of CSF leakage, 1 case of epidural hematoma, 1 case of pleural effusion, and 1 case of pneumothorax. Age, preoperative kyphotic angle, anteroposterior length of T-OPLL at the maximally affected level, and mass occupying rate were identified as predictors associated with postoperative outcome. A multivariate regression analysis revealed that age and preoperative kyphotic angle were independent risk factors for postoperative outcomes.CONCLUSIONSTransthoracic microsurgical anterior decompression without fusion achieved favorable clinical and radiological outcomes for treating T-OPLL with myelopathy. Patient age and preoperative kyphotic angle were independent risk factors for lower recovery rate.

Spinal cord herniation after multilevel anterior cervical corpectomy and fusion for ossification of the posterior longitudinal ligament of the cervical spine

2009 ◽  
Vol 10 (3) ◽  
pp. 240-243 ◽  
Author(s):  
Jun-Hong Min ◽  
Byung-Joo Jung ◽  
Jee-Soo Jang ◽  
Seok-Kang Kim ◽  
Dae-Jin Jung ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Anterior Approach ◽  
Posterior Longitudinal Ligament ◽  
Neurological Deterioration ◽  
Dural Defect ◽  
Cervical Corpectomy ◽  
Spinal Cord Herniation ◽  
Ossified Posterior Longitudinal Ligament ◽  
Anterior Cervical Corpectomy

The authors report the case of a 52-year-old man who had undergone resection of an ossified posterior longitudinal ligament via the anterior approach. The patient experienced postoperative neurological deterioration that may have been caused by a massive cord herniation associated with a dural defect at the corpectomy site. Spinal cord herniation may develop as a complication of anterior cervical decompression. Surgeons should be alert to this condition when planning to treat cervical ossification of the ossified posterior longitudinal ligament via the anterior approach.

Case report of ervical myelopathy due to ossification of the posterior longitudinal ligament in association with flavum ligament ossification: MRI and CT appearance

2013 ◽  
Vol 20 (2) ◽  
pp. 79-83
Author(s):  
Monique Boukobza ◽  
Jurgita Ušinskienė ◽  
Simona Letautienė
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Double Layer ◽  
Spinal Canal ◽  
Mixed Type ◽  
Cervical Spinal Cord ◽  
Asian Population ◽  
Posterior Longitudinal Ligament ◽  
Cord Compression ◽  
Cord Injury

Background. Our objective is to analyze the cervical spinal cord damage and spinal canal stenosis due to OPLL which usually affects the cervical spine and leads to progressive myelopathy in 50–60s in Asian population; to demonstrate the mixed type OPLL and to show OPLL specific dural penetration signs: “double- layer” and “C-sign” on imaging. Materials and methods. Subacute cord compression developed over a 3-month period in a 43-year-old Japanese patient. Severe spinal canal narrowing was related to the mixed type OPLL at C3–C4 through C6–C7 associated to flavum ligament ossification at T3–T4. Lateral radiograph of the cervical spine showed intraspinal ossification, CT demonstrated specific dural penetration signs, and MRI disclosed spinal cord compression. Laminectomy at C3–C7 was performed and decompression of the spinal cord was confirmed by postoperative MRI. Conclusions. Absolute cervical stenosis and association with other diseases (like calcification of flavum ligament) predispose the patient to develop more severe deficit earlier in the clinical course. Specific CT signs, “double-layer” and “C-sign”, show dural involvement. MRI is a very useful modality to identify the precise level and extent of the spinal cord injury. OPLL must be included in the differential diagnosis of subacute cervical myelopathy.

Sign in / Sign up

Export Citation Format

Share Document