scholarly journals Robotic Shoulder Rehabilitation With the Hybrid Assistive Limb in a Patient With Delayed Recovery After Postoperative C5 Palsy: A Case Report

2021 ◽  
Vol 12 ◽  
Author(s):  
Shigeki Kubota ◽  
Hideki Kadone ◽  
Yukiyo Shimizu ◽  
Hiroshi Takahashi ◽  
Masao Koda ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Spine Surgery ◽  
Deltoid Muscle ◽  
Abduction Angle ◽  
Shoulder Abduction ◽  
Wearable Robot ◽  
Cervical Spine Surgery ◽  
C5 Palsy ◽  
Delayed Recovery ◽  
Hybrid Assistive Limb

C5 palsy is a serious complication that may occur after cervical spine surgery; however, standard procedures for shoulder rehabilitation for patients with postoperative C5 palsy have not yet been established. We used a wearable robot suit Hybrid Assistive Limb (HAL) in a patient with delayed recovery after postoperative C5 palsy and conducted shoulder abduction training with the HAL. A 62-year-old man presented with weakness in his left deltoid muscle 2 days after cervical spine surgery. He experienced great difficulty in elevating his left arm and was diagnosed with postoperative C5 palsy. Seven months after surgery, shoulder abduction training with a HAL was initiated. In total, 23 sessions of shoulder HAL rehabilitation were conducted until 26 months after surgery. His shoulder abduction angle and power improved at every HAL session, and he was able to fully elevate his arm without any compensatory movement after the 23rd session, suggesting that the HAL is a useful tool for shoulder rehabilitation in patients with postoperative C5 palsy. We employed shoulder HAL training for a patient with delayed recovery from postoperative C5 palsy and achieved complete restoration of shoulder function. We believe that the HAL-based training corrected the erroneous motion pattern of his paralyzed shoulder and promoted errorless motor learning for recovery. Our collective experience suggests that shoulder HAL training could be an effective therapeutic tool for patients with postoperative C5 palsy.

scholarly journals Transient brain stem ischemia following cervical spine surgery: An unusual cause of delayed recovery

2014 ◽  
Vol 30 (3) ◽  
pp. 432 ◽  
Author(s):  
Nirmala Jonnavithula ◽  
Kavya Cherukuri ◽  
Padmaja Durga ◽  
DilipKumar Kulkarni ◽  
Vijayasaradhi Mudumba ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Brain Stem ◽  
Spine Surgery ◽  
Cervical Spine Surgery ◽  
Delayed Recovery ◽  
Brain Stem Ischemia

Efficacy of intraoperative monitoring of transcranial electrical stimulation–induced motor evoked potentials and spontaneous electromyography activity to identify acute-versus delayed-onset C-5 nerve root palsy during cervical spine surgery

2013 ◽  
Vol 19 (4) ◽  
pp. 395-402 ◽  
Author(s):  
Vidya M. Bhalodia ◽  
Daniel M. Schwartz ◽  
Anthony K. Sestokas ◽  
Gary Bloomgarden ◽  
Thomas Arkins ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Cervical Spine ◽  
Spine Surgery ◽  
Nerve Root ◽  
Deltoid Muscle ◽  
Transcranial Electrical Stimulation ◽  
Cervical Spine Surgery ◽  
Nerve Root Injury ◽  
Delayed Onset ◽  
Root Injury

Object Deltoid muscle weakness due to C-5 nerve root injury following cervical spine surgery is an uncommon but potentially debilitating complication. Symptoms can manifest upon emergence from anesthesia or days to weeks following surgery. There is conflicting evidence regarding the efficacy of spontaneous electromyography (spEMG) monitoring in detecting evolving C-5 nerve root compromise. By contrast, transcranial electrical stimulation–induced motor evoked potential (tceMEP) monitoring has been shown to be highly sensitive and specific in identifying impending C-5 injury. In this study the authors sought to 1) determine the frequency of immediate versus delayed-onset C-5 nerve root injury following cervical spine surgery, 2) identify risk factors associated with the development of C-5 palsies, and 3) determine whether tceMEP and spEMG neuromonitoring can help to identify acutely evolving C-5 injury as well as predict delayed-onset deltoid muscle paresis. Methods The authors retrospectively reviewed the neuromonitoring and surgical records of all patients who had undergone cervical spine surgery involving the C-4 and/or C-5 level in the period from 2006 to 2008. Real-time tceMEP and spEMG monitoring from the deltoid muscle was performed as part of a multimodal neuromonitoring protocol during all surgeries. Charts were reviewed to identify patients who had experienced significant changes in tceMEPs and/or episodes of neurotonic spEMG activity during surgery, as well as those who had shown new-onset deltoid weakness either immediately upon emergence from the anesthesia or in a delayed fashion. Results Two hundred twenty-nine patients undergoing 235 cervical spine surgeries involving the C4–5 level served as the study cohort. The overall incidence of perioperative C-5 nerve root injury was 5.1%. The incidence was greatest (50%) in cases with dual corpectomies at the C-4 and C-5 spinal levels. All patients who emerged from anesthesia with deltoid weakness had significant and unresolved changes in tceMEPs during surgery, whereas only 1 had remarkable spEMG activity. Sensitivity and specificity of tceMEP monitoring for identifying acute-onset deltoid weakness were 100% and 99%, respectively. By contrast, sensitivity and specificity for spEMG were only 20% and 92%, respectively. Neither modality was effective in identifying patients who demonstrated delayed-onset deltoid weakness. Conclusions The risk of new-onset deltoid muscle weakness following cervical spine surgery is greatest for patients undergoing 2-level corpectomies involving C-4 and C-5. Transcranial electrical stimulation–induced MEP monitoring is a highly sensitive and specific technique for detecting C-5 radiculopathy that manifests immediately upon waking from anesthesia. While the absence of sustained spEMG activity does not rule out nerve root irritation, the presence of excessive neurotonic discharges serves both to alert the surgeon of such potentially injurious events and to prompt neuromonitoring personnel about the need for additional tceMEP testing. Delayed-onset C-5 nerve root injury cannot be predicted by intraoperative neuromonitoring via either modality.

scholarly journals Epidemiology of C5 Palsy after Cervical Spine Surgery: A 21-Center Study

Neurospine ◽  
2019 ◽  
Vol 16 (3) ◽  
pp. 558-562 ◽  
Author(s):  
Jae Keun Oh ◽  
Jae Taek Hong ◽  
Dong Ho Kang ◽  
Sang-Woo Kim ◽  
Seok Won Kim ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Spine Surgery ◽  
Cervical Spine Surgery ◽  
C5 Palsy ◽  
Center Study

281. C5 palsy and neurological complications after cervical spine surgery

2019 ◽  
Vol 19 (9) ◽  
pp. S137
Author(s):  
Dominic J. Carusillo ◽  
Ali Siddiqui ◽  
Blake G. Formanek ◽  
Raymond J. Hah ◽  
Zorica Buser ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Spine Surgery ◽  
Neurological Complications ◽  
Cervical Spine Surgery ◽  
C5 Palsy

scholarly journals C5 Palsy After Cervical Spine Surgery: A Multicenter Retrospective Review of 59 Cases

2017 ◽  
Vol 7 (1_suppl) ◽  
pp. 64S-70S ◽  
Author(s):  
Sara E. Thompson ◽  
Zachary A. Smith ◽  
Wellington K. Hsu ◽  
Ahmad Nassr ◽  
Thomas E. Mroz ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Spine Surgery ◽  
Retrospective Review ◽  
Cervical Spine Surgery ◽  
C5 Palsy ◽  
Multicenter Retrospective Review

scholarly journals Critical points and effectiveness of prophylactic C4/5 foraminotomy to prevent C5 palsy after posterior cervical spine surgery

2021 ◽  
Vol 55 (6) ◽  
pp. 527-534
Author(s):  
Kazunari Takeuchi ◽  
◽  
Toru Yokoyama ◽  
Kanichiro Wada ◽  
Gentaro Kumagai ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Spine Surgery ◽  
Critical Points ◽  
Cervical Spine Surgery ◽  
C5 Palsy

Use of electromyography to predict likelihood of recovery following C5 palsy after posterior cervical spine surgery

2020 ◽  
Author(s):  
Daniel Lubelski ◽  
Zach Pennington ◽  
Ryan F. Planchard ◽  
Ahmet Hoke ◽  
Nicholas Theodore ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Spine Surgery ◽  
Cervical Spine Surgery ◽  
C5 Palsy

Application of Smith-Robinson approach for C2/3 cervical spine surgery

2013 ◽  
Vol 32 (11) ◽  
pp. 1199-1202
Author(s):  
Ying ZHANG ◽  
Jun MA ◽  
Yuan-yuan CHEN ◽  
Xin-wei WANG ◽  
De-yu CHEN ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Spine Surgery ◽  
Cervical Spine Surgery

scholarly journals Impact of Diabetes Mellitus on Cervical Spine Surgery for Ossification of the Posterior Longitudinal Ligament

2021 ◽  
Vol 10 (15) ◽  
pp. 3375
Author(s):  
Atsushi Kimura ◽  
Katsushi Takeshita ◽  
Toshitaka Yoshii ◽  
Satoru Egawa ◽  
Takashi Hirai ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Cervical Spine ◽  
Postoperative Complications ◽  
Spine Surgery ◽  
Posterior Longitudinal Ligament ◽  
Lower Extremity Function ◽  
Cervical Spine Surgery ◽  
The Impact

Ossification of the posterior longitudinal ligament (OPLL) is commonly associated with diabetes mellitus (DM); however, the impact of DM on cervical spine surgery for OPLL remains unclear. This study was performed to evaluate the influence of diabetes DM on the outcomes following cervical spine surgery for OPLL. In total, 478 patients with cervical OPLL who underwent surgical treatment were prospectively recruited from April 2015 to July 2017. Functional measurements were conducted at baseline and at 6 months, 1 year, and 2 years after surgery using JOA and JOACMEQ scores. The incidence of postoperative complications was categorized into early (≤30 days) and late (>30 days), depending on the time from surgery. From the initial group of 478 patients, 402 completed the 2-year follow-up and were included in the analysis. Of the 402 patients, 127 (32%) had DM as a comorbid disease. The overall incidence of postoperative complications was significantly higher in patients with DM than in patients without DM in both the early and late postoperative periods. The patients with DM had a significantly lower JOA score and JOACMEQ scores in the domains of lower extremity function and quality of life than those without DM at the 2-year follow-up.

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