Lubelski Daniel, Derakhshan Adeeb, Nowacki Amy S, Wang Jeffrey C, Steinmetz Michael P, Benzel Edward C, Mroz Thomas E
Cleveland Clinic Lerner College of Medicine, 9500 Euclid Ave., NA-20, Cleveland, OH 44195, USA; Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave., S-40, Cleveland, OH 44195, USA; Department of Neurological Surgery, Cleveland Clinic, 9500 Euclid Ave., S-40, Cleveland, OH 44195, USA.
Department of Quantitative Health Sciences, Cleveland Clinic, 9500 Euclid Ave., NB-21, Cleveland, OH 44195, USA.
Spine J. 2014 Sep 1;14(9):1895-901. doi: 10.1016/j.spinee.2013.10.038. Epub 2013 Nov 10.
C5 nerve root palsy (C5P) is a relatively rare complication after anterior and posterior cervical decompression surgery that leads to a variety of debilitating symptoms. The precise etiology remains obscure, and a clear understanding of preoperative risk factors for C5P development does not exist.
To determine whether postoperative C5P can be predicted from preoperative anteroposterior diameter (APD), foraminal diameter (FD), and/or cord-lamina angle (CLA).
Retrospective review.
Consecutive patients who underwent either anterior or posterior decompression surgery at C4-C5 for cervical spondylotic myelopathy.
Development of C5P.
Blinded reviewers retrospectively assessed magnetic resonance images for each included patient's C4-C5 interspace, including the midline APD, the left and right FDs, and the left and right CLA. Multivariable logistic regression was used to model the probability of palsy on the basis of one or more predictors. A jackknife validation was performed to internally validate the model and assess its generalizability.
A total of 98 patients fit the inclusion criteria; 12% had developed symptoms of C5 palsy postoperatively. Using the three variables in a predictor-model, we found that the odds ratio of having palsy for APD, FD, and CLA was 0.3, 0.02, and 1.4, respectively. For every 1-mm increase in APD and FD, the odds of developing palsy decrease 69% (p<.0001) and decrease 98% (p<.0003), respectively. In contrast, for every 1-degree increase in CLA, the odds of developing palsy increase by 43% (p<.0001). The receiver-operating characteristic curve for this three-variable model predicting development of palsy has an area under the curve (concordance index) of 0.97. After implementing a jackknife validation, the area under the curve was 95%.
This study is the first to use the combination of APD, FD, and CLA to predict development of postoperative C5 palsy after decompression surgery for patients with spondylotic myelopathy. This prediction formula may allow for better patient selection and to prepare patients that have an increased probability of developing this complication.
C5神经根麻痹（C5P）是颈椎前后路减压手术后一种相对罕见的并发症，会导致多种使人衰弱的症状。确切病因仍不清楚，对于C5P发生的术前危险因素尚无明确认识。
确定能否根据术前的前后径（APD）、椎间孔直径（FD）和/或脊髓-椎板角（CLA）预测术后C5P。
回顾性研究。
因脊髓型颈椎病在C4-C5行前路或后路减压手术的连续患者。
C5P的发生情况。
不知情的评估人员对纳入研究的每位患者的C4-C5间隙的磁共振成像进行回顾性评估，包括中线APD、左右FD以及左右CLA。多变量逻辑回归用于根据一个或多个预测因素对麻痹发生概率进行建模。采用留一法验证对模型进行内部验证并评估其可推广性。
共有98例患者符合纳入标准；12%的患者术后出现C5麻痹症状。在预测模型中使用这三个变量，我们发现APD、FD和CLA发生麻痹的比值比分别为0.3、0.02和1.4。APD和FD每增加1毫米，发生麻痹的几率分别降低69%（p<0.0001）和降低98%（p<0.0003）。相反，CLA每增加1度，发生麻痹的几率增加43%（p<0.0001）。这个预测麻痹发生的三变量模型的受试者工作特征曲线下面积（一致性指数）为0.97。在实施留一法验证后，曲线下面积为95%。
本研究首次使用APD、FD和CLA的组合来预测脊髓型颈椎病患者减压手术后C5麻痹的发生。这个预测公式可能有助于更好地选择患者，并让发生这种并发症可能性增加的患者做好准备。
