Sasai Kunihiko, Saito Takanori, Akagi Shigeo, Kato Isashi, Ohnari Hiroyuki, Iida Hirokazu
Department of Orthopaedic Surgery, Kansai Medical University, Osaka, Japan.
Spine (Phila Pa 1976). 2003 Sep 1;28(17):1972-7. doi: 10.1097/01.BRS.0000083237.94535.46.
STUDY DESIGN: The incidences of postoperative C5 palsy between a group treated by a standardized diagnostic and surgical treatment and a control group treated by a different cervical laminoplastic technique were prospectively compared. OBJECTIVE: To investigate the cause, risk factors, and prevention of C5 palsy after laminoplasty for cervical myelopathy. SUMMARY OF BACKGROUND DATA: No one factor could predict postoperative C5 palsy, although postoperative C5 palsy is a clinically significant complication of cervical laminoplasty. METHODS: One hundred eleven patients who underwent laminoplasty for cervical myelopathy were studied. Seventy-four patients who consulted two spinal surgeons (two of the authors) were placed into Group A. Thirty-seven patients who consulted the other two spinal surgeons (the other two authors) were placed into Group B. There were no statistical differences between the two groups for age at operation, gender, spinal disorders, preoperative neurologic severity, and length of the follow-up period. All patients in Group A underwent preoperative electromyographic testing. Patients with no electromyographic abnormalities underwent a standard midsagittal laminoplasty. Those with preoperative electromyographic abnormalities, reflecting a subclinical radiculopathy, underwent a modified en bloc laminoplasty with microcervical foraminotomy done at each level of the EMG abnormality. All Group B patients underwent midsagittal laminoplasty without preoperative electromyographic testing. Microcervical foraminotomy was performed for C5 root in 11 patients (14.9%) of Group A. RESULTS: No patients in Group A and three patients (8.1%) in Group B experienced postoperative C5 palsy. This difference was statistically significant (P = 0.035, Fisher's exact method). CONCLUSIONS: Electromyography is a sensitive predictor of postoperative C5 palsy after laminoplasty. This complication may be avoided by performing selective foraminotomy in addition to posterior central canal decompression. Preexisting subclinical C5 root compression is a cause of C5 palsy after posterior cervical decompression for myelopathy.
研究设计：前瞻性比较一组接受标准化诊断和手术治疗的患者与另一组采用不同颈椎椎板成形术技术治疗的对照组术后C5麻痹的发生率。 目的：探讨颈椎脊髓病椎板成形术后C5麻痹的病因、危险因素及预防措施。 背景资料总结：尽管术后C5麻痹是颈椎椎板成形术的一种具有临床意义的并发症，但尚无单一因素可预测术后C5麻痹。 方法：对111例行颈椎脊髓病椎板成形术的患者进行研究。74例咨询两位脊柱外科医生（两位作者）的患者被纳入A组。37例咨询另外两位脊柱外科医生（另外两位作者）的患者被纳入B组。两组在手术年龄、性别、脊柱疾病、术前神经功能严重程度及随访时间方面无统计学差异。A组所有患者术前行肌电图检查。肌电图无异常的患者接受标准的矢状位椎板成形术。术前肌电图异常提示亚临床神经根病的患者，在肌电图异常的每个节段行改良整块椎板成形术并加做微型颈椎椎间孔切开术。B组所有患者未术前行肌电图检查，均接受矢状位椎板成形术。A组11例患者（14.9%）对C5神经根行微型颈椎椎间孔切开术。 结果：A组无患者发生术后C5麻痹，B组有3例患者（8.1%）发生术后C5麻痹。这种差异具有统计学意义（P = 0.035，Fisher精确检验法）。 结论：肌电图是椎板成形术后C5麻痹的敏感预测指标。除后路中央管减压外，行选择性椎间孔切开术可避免该并发症。术前存在的亚临床C5神经根受压是颈椎后路脊髓病减压术后C5麻痹的一个原因。
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