Takeuchi Mikinobu, Wakao Norimitsu, Kamiya Mitsuhiro, Hirasawa Atsuhiko, Murotani Kenta, Takayasu Masakazu
1Spine Center.
2Department of Neurological Surgery.
J Neurosurg Spine. 2018 Oct;29(4):365-370. doi: 10.3171/2018.2.SPINE171363. Epub 2018 Jul 6.
The incidence of C5 palsy after cervical laminoplasty is approximately 5%. Because C5 palsy is related to cervical foraminal stenosis at the C4-5 level, the authors hypothesized that cervical foraminal stenosis can be diagnosed by examining the C5 nerve root (NR) using ultrasonography. The purpose of this study was to investigate whether postoperative C5 palsy could be predicted using ultrasonography.
This study used a prospective diagnosis design. In total, 140 patients undergoing cervical laminoplasty were examined with ultrasound. The cross-sectional area (CSA) of the C5 NR was measured on both sides before surgery, and the incidence of postoperative C5 palsy was examined. The difference between the CSA of the patients with and without C5 palsy and the lateral differences in the C5 palsy group were determined.
The incidence of C5 palsy was 5% (7 cases). Symptoms manifested at a median of 5 days after surgery (range 1-29 days). The CSA of the C5 NR on the affected side was significantly enlarged in the C5 palsy group compared with that in the no-C5 palsy group (p = 0.001). In addition, in the patients who had C5 palsy, the CSA of the C5 NR was significantly enlarged on the affected side compared with that on the unaffected side (p = 0.02). Receiver operating characteristic analysis indicated that the best threshold value for the CSA of the C5 NR was 10.4 mm, which provided 91% sensitivity and 71% specificity.
C5 palsy may be predicted preoperatively using ultrasound. The authors recommend the ultrasonographic measurement of the CSA of the C5 NR prior to cervical laminoplasty.
颈椎椎板成形术后C5麻痹的发生率约为5%。由于C5麻痹与C4-5水平的颈椎椎间孔狭窄有关，作者推测可通过超声检查C5神经根（NR）来诊断颈椎椎间孔狭窄。本研究的目的是探讨超声检查能否预测术后C5麻痹。
本研究采用前瞻性诊断设计。对总共140例行颈椎椎板成形术的患者进行超声检查。术前测量双侧C5 NR的横截面积（CSA），并检查术后C5麻痹的发生率。确定有和无C5麻痹患者的CSA差异以及C5麻痹组的侧方差异。
C5麻痹的发生率为5%（7例）。症状在术后中位5天出现（范围1-29天）。与无C5麻痹组相比，C5麻痹组患侧C5 NR的CSA明显增大（p = 0.001）。此外，在发生C5麻痹的患者中，患侧C5 NR的CSA明显大于未患侧（p = 0.02）。受试者工作特征分析表明，C5 NR的CSA最佳阈值为10.4 mm，灵敏度为91%，特异度为71%。
术前可通过超声预测C5麻痹。作者建议在颈椎椎板成形术前对C5 NR的CSA进行超声测量。
