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C5 nerve palsy after posterior reconstruction surgery: predictive risk factors of the incidence and critical range of correction for kyphosis.
- Source :
-
European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society [Eur Spine J] 2016 Jul; Vol. 25 (7), pp. 2060-7. Date of Electronic Publication: 2016 Apr 07. - Publication Year :
- 2016
-
Abstract
- Purpose: It has been reported that the incidence of post-operative segmental nerve palsy, such as C5 palsy, is higher in posterior reconstruction surgery than in conventional laminoplasty. Correction of kyphosis may be related to such a complication. The aim of this study was to elucidate the risk factors of the incidence of post-operative C5 palsy, and the critical range of sagittal realignment in posterior instrumentation surgery.<br />Methods: Eighty-eight patients (mean age 64.0 years) were involved. The types of the disease were; 33 spondylosis with kyphosis, 27 rheumatoid arthritis, 17 athetoid cerebral palsy and 11 others. The patients were divided into two groups; Group P: patients with post-operative C5 palsy, and Group NP: patients without C5 palsy. The correction angle of kyphosis, and pre-operative diameter of C4/5 foramen on CT were evaluated between the two groups. Multivariate logistic regression analysis was used to determine the critical range of realignment and the risk factors affecting the incidence of post-operative C5 palsy.<br />Results: Seventeen (19.3 %) of the 88 patients developed C5 palsy. The correction angle of kyphosis in Group P (15.7°) was significantly larger than that in Group NP (4.5°). In Group P, pre-operative diameters of intervertebral foramen at C4/5 (3.2 mm) were significantly smaller than those in Group NP (4.1 mm). The multivariate analysis demonstrated that the risk factors were the correction angle and pre-operative diameter of the C4/5 intervertebral foramen. The logistic regression model showed a correction angle exceeding 20° was critical for developing the palsy when C4/5 foraminal diameter reaches 4.1 mm, and there is a higher risk when the C4/5 foraminal diameter is less than 2.7 mm regardless of any correction.<br />Conclusions: This study has indicated the risk factors of post-operative C5 palsy and the critical range of realignment of the cervical spine after posterior instrumented surgery.
- Subjects :
- Adult
Aged
Aged, 80 and over
Arthritis, Rheumatoid complications
Cerebral Palsy complications
Female
Humans
Incidence
Kyphosis complications
Laminoplasty methods
Male
Middle Aged
Orthopedic Procedures methods
Plastic Surgery Procedures methods
Risk Factors
Severity of Illness Index
Spinal Cord Compression etiology
Spondylosis complications
Arthritis, Rheumatoid surgery
Cerebral Palsy surgery
Cervical Vertebrae surgery
Kyphosis surgery
Peripheral Nervous System Diseases epidemiology
Postoperative Complications epidemiology
Spinal Cord Compression surgery
Spinal Fusion methods
Spondylosis surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1432-0932
- Volume :
- 25
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
- Publication Type :
- Academic Journal
- Accession number :
- 27055443
- Full Text :
- https://doi.org/10.1007/s00586-016-4548-7