Takemitsu Masakazu, Cheung Kenneth M C, Wong Yat Wa, Cheung Wai-Yuen, Luk Keith D K
Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong, China.
J Spinal Disord Tech. 2008 Jun;21(4):267-72. doi: 10.1097/BSD.0b013e31812f6f54.
Consecutive case series.
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.
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.
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.
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.
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.
连续病例系列。
比较单纯椎板成形术与后路内固定椎板成形术治疗颈椎病患者术后第五颈神经根麻痹（C5麻痹）的发生率及临床特征。
对于患有多节段颈椎病且后凸畸形可复位或不稳定的患者，作者进行了椎板成形术并结合器械融合以恢复前凸和稳定性。这些患者术后C5麻痹的发生率似乎较高。
回顾了1995年至2005年接受椎板成形术治疗的73例平均年龄60.5岁的多节段颈椎病患者。比较后路器械融合术后（器械组）C5麻痹患者与未行器械融合患者（非器械组）肌肉无力的发生率、部位及严重程度。评估影像学参数以确定易感因素。
73例患者中共有10例（14%）发生C5麻痹，其中器械组10例中有5例（50%），非器械组63例中有5例（8%）。器械组5例中有3例（60%）麻痹发生在打开椎板的同侧，与非器械组比例相同。器械组3例（60%）患者三角肌无力为1级，但非器械组无弱于3级的情况。器械组所有麻痹患者在术后2年内均未取出植入物而恢复。器械组5例麻痹患者中，3例术前存在椎体前滑脱，手术导致C4在C5上向后移位，而无麻痹的患者均无椎体前滑脱。
对于多节段颈椎病和C4椎体前滑脱患者，使用器械进行颈椎后路融合以恢复前凸对线并结合椎板成形术与严重的术后C5麻痹高度相关。
