The Incidence of C5 Palsy After Multilevel Cervical Decompression Procedures A Review of 750 Consecutive Cases
The Incidence of C5 Palsy After Multilevel Cervical Decompression Procedures A Review of 750 Consecutive Cases
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DOI：
10.1097/brs.0b013e318219cfe9
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发表时间：
2012-02-01
期刊：
影响因子：
3
通讯作者：
Kang, James D.
中科院分区：
文献类型：
--
作者：
Nassr, Ahmad;Eck, Jason C.;Kang, James D.
研究设计。对同一脊柱外科医生连续进行的 750 例多节段颈椎减压手术进行回顾性分析。目的。确定在一系列连续的多级颈椎减压手术中 C5 麻痹的发生率。背景数据摘要。 C5 神经麻痹是颈椎手术的一种众所周知的潜在并发症，据报告发生率范围为 0% 至 30%。病因尚不清楚，但可归因于手术期间的医源性损伤、脊髓移位、脊髓缺血和脊髓再灌注损伤。方法。我们纳入了接受多节段颈椎椎体切除术、后路融合椎体切除术、后路椎板切除术和融合术以及椎板成形术的患者。排除标准包括缺乏随访数据、脊髓损伤妨碍术前或术后运动测试或不涉及 C5 水平的手术。确定并比较 C5 麻痹的发生率，以确定不同手术、患者年龄、性别、翻修手术、术前虚弱、糖尿病、吸烟、减压节数以及既往上肢手术史之间是否存在显着差异。结果。在 750 名患者中，根据排除标准排除了 120 名患者。分析中纳入的 630 名患者包括 292 名女性和 338 名男性。平均年龄为 58 岁（范围：19-87 岁）。全组 C5 神经麻痹的发生率为 630 例中的 42 例（6.7%）。椎板切除融合组的发生率最高（9.5%），其次是椎板切除加后路融合组（8.4%）、椎板切除组（5.1%），最后是椎板成形术组（4.8%），但这些差异没有达到统计学意义。男性发病率明显较高（8.6% vs. 4.5%，P = 0.05）。结论。颈椎减压术后C5神经麻痹的发生率为6.7%。这与之前发表的研究一致，代表了迄今为止最大的北美患者系列。尽管椎板切除术和融合术的发生率有更高的趋势，但基于手术方式的 C5 麻痹发生率没有统计学上的显着差异。
Study Design. Retrospective review of 750 consecutive multilevel cervical spine decompression surgeries performed by a single spine surgeon.Objective. To determine the incidence of C5 palsy in a large consecutive series of multilevel cervical spine decompression procedures.Summary of Background Data. Palsy of the C5 nerve is a well-known potential complication of cervical spine surgery with reported rates ranging from 0% to 30%. The etiology remains uncertain but has been attributed to iatrogenic injury during surgery, tethering from shifting of the spinal cord, spinal cord ischemia, and reperfusion injury of the spinal cord.Methods. We included patients undergoing multilevel cervical corpectomy, corpectomy with posterior fusion, posterior laminectomy and fusion, and laminoplasty. Exclusion criteria included lack of follow-up data, spinal cord injury preventing preoperative or postoperative motor testing, or surgery not involving the C5 level. Incidence of C5 palsy was determined and compared to determine whether significant differences existed among the various procedures, patient age, sex, revision surgery, preoperative weakness, diabetes, smoking, number of levels decompressed, and history of previous upper extremity surgery.Results. Of the 750 patients, 120 were eliminated on the basis of the exclusion criteria. The 630 patients included in the analysis consisted of 292 females and 338 males. The mean age was 58 years (range, 19-87). The incidence of C5 nerve palsy for the entire group was 42 of 630 (6.7%). The incidence was highest for the laminectomy and fusion group (9.5%), followed by the corpectomy with posterior fusion group (8.4%), the corpectomy group (5.1%), and finally the laminoplasty group (4.8%), although these differences did not reach statistical significance. There was a significantly higher incidence in males (8.6% vs. 4.5%, P = 0.05).Conclusion. Incidence of C5 nerve palsy after cervical spine decompression was 6.7%. This is consistent with previously published studies and represents the largest series of North American patients to date. There is no statistically significant difference in incidence of C5 palsy based on surgical procedure, although there was a trend toward higher rates with laminectomy and fusion.