Greiner-Perth Ralph, Elsaghir Hesham, Böhm Heinrich, El-Meshtawy Mohamed
Department of Orthopedics, Spine Surgery and Paraplegiology, Bad Berka, Germany.
Neurosurg Rev. 2005 Apr;28(2):137-42. doi: 10.1007/s10143-004-0352-7. Epub 2004 Sep 15.
This retrospective study aims to discuss and compare our results with those previously mentioned in the literature with regard to C5-C6 radiculopathy that occurs after decompression carried out for cervical spondylotic myelopathy. There are few reports in the literature referring to the incidence of the C5-C6 radiculopathy following cervical decompression procedures. Some authors believe that the postoperative cord shift is the most likely cause. From January 1994 to November 2002, 121 patients underwent cervical corpectomies for cervical spondylotic myelopathy. The preoperative and the postoperatively discovered paresis have been assessed according to the criteria of the British Medical Council. The Nurick Scale was used to grade the severity of the myelopathic changes. The follow-up period varied from 4 to 111 months with an average of 50 months. Symptoms of C5 and/or C6 radiculopathy appeared in 10 patients (8.2%) postoperatively. Aggravation of a preoperative C5 and/or C6 radiculopathy was seen in 3 patients, while 7 patients developed a new C5 and/or C6 radiculopathy in the immediate postoperative period. These motor deficits resolved completely in 7 patients within 7 months of surgery, whereas a residual motor weakness remained in the other 3 patients. The postoperative C5 motor deficit is not infrequently associated with partial involvement of the C6 root. The lesions can be either unilateral or bilateral with a statistically average frequency of 8%. The prognosis is generally favorable. Our results did not support the hypothesis that the claimed cord shift phenomenon is a possible aetiology.
本回顾性研究旨在讨论并比较我们关于脊髓型颈椎病减压术后发生C5-C6神经根病的结果与文献中先前提及的结果。文献中很少有关于颈椎减压术后C5-C6神经根病发生率的报道。一些作者认为术后脊髓移位是最可能的原因。1994年1月至2002年11月,121例患者因脊髓型颈椎病接受了颈椎椎体次全切除术。术前和术后发现的轻瘫已根据英国医学委员会的标准进行评估。采用努里克量表对脊髓病变的严重程度进行分级。随访时间为4至111个月,平均50个月。10例患者(8.2%)术后出现C5和/或C6神经根病症状。3例患者术前C5和/或C6神经根病加重,7例患者在术后即刻出现新的C5和/或C6神经根病。7例患者的这些运动功能障碍在术后7个月内完全恢复,而另外3例患者仍残留运动无力。术后C5运动功能障碍常与C6神经根部分受累有关。病变可为单侧或双侧,统计学平均发生率为8%。预后一般良好。我们的结果不支持所声称的脊髓移位现象是可能病因这一假说。