C5 nerve root palsy after cervical laminoplasty and posterior fusion with instrumentation
C5 nerve root palsy after cervical laminoplasty and posterior fusion with instrumentation
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DOI：
10.1097/bsd.0b013e31812f6f54
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发表时间：
2008-06-01
影响因子：
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通讯作者：
Luk, Keith D. K.
中科院分区：
文献类型：
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作者：
Takemitsu, Masakazu;Cheung, Kenneth M. C.;Luk, Keith D. K.
研究设计：连续病例系列。目的：比较单纯椎板成形术和椎板成形术联合后路instrument.Summary背景资料：对于多节段颈椎病伴可复位脊柱后凸或不稳定的患者，作者进行了椎板成形术联合后路内固定融合术，以恢复脊柱前凸和稳定性。似乎有一个术后C5麻痹的发病率很高，在这些patients.Methods：73例患者的平均年龄为60.5岁，多节段颈椎病治疗椎板成形术从1995年至2005年进行了审查。比较后路内固定融合术后C5麻痹患者（内固定组）与未内固定患者（非内固定组）肌无力的发生率、侧位和严重程度。影像学参数进行了评估，以确定诱发factors.Results：总体上10 73例（14%）的患者开发的C5麻痹，其中5（50%）的10例患者是在仪器组，5 63例（8%）的患者是在noninstrumented。内固定组5例中有3例（60%）在开放椎板的同侧出现麻痹，与非内固定组的比例相同。内固定组中有3例（60%）患者出现1级三角肌无力，但非内固定组中无1例弱于3级。内固定组所有麻痹患者均在术后2年内恢复，未取出植入物。内固定组5例麻痹患者中，3例术前有前滑脱，手术后C4在C5上平移，无麻痹患者发生前滑脱。在多节段颈椎病和C4颈椎病患者中，采用后路颈椎融合术联合椎板成形术恢复脊柱前凸对线与术后严重C5麻痹高度相关。前滑脱
Study Design: Consecutive case series.Objective: To compare the incidence and clinical characteristics of postoperative fifth cervical nerve root palsy (C5 palsy) in patients with cervical myelopathy treated by laminoplasty alone and laminoplasty with posterior instrumentation.Summary of Background Data: In patients who have multilevel cervical myelopathy with reducible kyphosis or instability, the authors have performed laminoplasty together with instrumented fusion to restore lordosis and stability. There seems to be a high incidence of postoperative C5 palsy in these patients.Methods: Seventy-three patients with a mean age of 60.5 years and multilevel cervical myelopathy treated by laminoplasty from 1995 to 2005 were reviewed. Incidence, side, and severity of muscle weakness from patients with C5 palsy after posterior instrumented fusion (instrumented group) was compared with those without instrumentation (noninstrumented group). Radiologic parameters were assessed to identify predisposing factors.Results: Overall 10 of 73 (14%) patients developed the C5 palsy, of which 5 (50%) of 10 patients were in instrumented group, and 5 of 63 (8%) patients were in noninstrumented. Three of 5 (60%) had the palsy on the same side of the opened lamina in the instrumented group, in the same proportion as the noninstrumented. Three (60%) patients in instrumented group developed deltoid weakness grade 1, but none in the noninstrumented had weaker than grade 3. All of the palsied in the instrumented group recovered within 2 years after surgery without removal of implant. Of the 5 patients with the palsy in the instrumented group, 3 had anterolisthesis before surgery and posterior translation of C4 on C5 by the surgery, and no patient without the palsy had the anterolisthesis.Conclusions: Posterior cervical fusion using instrumentation for restoration of lordotic alignment combined with laminoplasty is highly associated with severe postoperative C5 palsy in patients with multilevel cervical myelopathy and C4 anterolisthesis.