C-5 palsy after cervical laminoplasty with instrumented posterior fusion

Clinical article

Kazuhiro Yamanaka M.D., Toshiya Tachibana M.D., Ph.D., Tokuhide Moriyama M.D., Ph.D., Fumiaki Okada M.D., Ph.D., Keishi Maruo M.D., Ph.D., Shinichi Inoue M.D., Ph.D., Yutaka Horinouchi M.D., and Shinichi Yoshiya M.D., Ph.D.
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  • Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
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Object

Postoperative C-5 palsy is known as a common complication after cervical laminoplasty. The authors of this article have encountered postoperative C-5 palsy more often when laminoplasty was combined with instrumented posterior spinal fusion than when it was performed alone. The purpose of this clinical study was to examine the incidence of fifth cervical nerve root palsy (C-5 palsy) and surgical results in patients with cervical myelopathy who had undergone laminoplasty with or without instrumented spinal fusion.

Methods

The authors retrospectively studied patients with cervical myelopathy who had undergone laminoplasty with or without instrumented posterior spinal fusion.

Results

Clinical data on 58 patients were evaluated and analyzed. Preoperative diagnoses were cervical spondylotic myelopathy or ossification of the posterior longitudinal ligament of the cervical spine. Twenty-four patients with spondylolisthesis or kyphosis underwent laminoplasty combined with posterior spinal fusion using instrumented lateral mass fixation (fusion group), while the remaining 34 patients underwent laminoplasty without posterior spinal fusion (no-fusion group). In the fusion group, C-5 palsy developed in 6 patients; in the no-fusion group, it occurred in only 1 patient. There was a significant difference in the rate of this complication between the 2 groups. In the fusion group, local kyphosis and spondylolisthesis level were reduced at the fusion level, and all patients with C-5 palsy underwent C4–5 spinal fusion.

Conclusions

The incidence of postoperative C-5 palsy is significantly higher after laminoplasty when it is combined with spinal fusion. Correction of kyphosis and spondylolisthesis using posterior instrumentation may be a risk factor for iatrogenic intervertebral foraminal stenosis leading to C-5 palsy.

Abbreviations used in this paper:JOA = Japanese Orthopaedic Association; MMT = manual muscle test; ROM = range of motion.

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Contributor Notes

Address correspondence to: Toshiya Tachibana, M.D., Ph.D., Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan. email: tachi@hyo-med.ac.jp.

Please include this information when citing this paper: published online October 25, 2013; DOI: 10.3171/2013.9.SPINE12952.

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