Takase Hajime, Murata Hidetoshi, Sato Mitsuru, Tanaka Takahiro, Miyazaki Ryohei, Yoshizumi Tetsuya, Tateishi Kensuke, Kawahara Nobutaka, Yamamoto Tetsuya
Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan.
Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan.
World Neurosurg. 2018 Dec;120:e1107-e1119. doi: 10.1016/j.wneu.2018.08.240. Epub 2018 Sep 12.
Postoperative C5 palsy is a well-known complication after cervical decompression with either a posterior or an anterior approach. Its cause has been discussed more regarding the posterior approach. The main hypothesis is that postoperative spinal cord shift causes root traction and palsy. However, the pathogenesis in anterior cases has not been fully described. Therefore, the purpose of this study was to clarify the risk factors for C5 palsy in the anterior approach through our C5 palsy cases.
A total of 149 surgical patients with an anterior cervical lesion were treated by a specific spinal surgeon under consistent same treatment strategy. Of these patients, 88 who satisfied the evaluation criteria were enrolled. Postoperative C5 palsy was defined as postoperative weakness of the deltoid with or without weakness of the biceps brachii. Risk factors of C5 palsy were extracted from clinical backgrounds, surgical approaches, and radiologic findings from patients with palsy.
Four sides of 3 individuals (4.6%) who underwent multiple corpectomy developed C5 palsy. All paralyses became evident several days after the surgery and recovered. Older age, multiple corpectomy, postoperative spinal cord shift, and foraminal stenosis of C4-5 and C5-6 were statistically extracted as causative factor of C5 palsy. In the patients with palsy, distortion of the anterior nerve root as a result of a residual vertebral spur was observed with anterior spinal cord shift after anterior corpectomy.
Multiple corpectomy for patients with longer anterior lesions and locally developed kyphosis is related to a larger postoperative cord shift, which can cause the occurrence of C5 palsy. Moreover, C4-5 or C5-6 foraminal stenosis can accelerate tethering of the C5 or C6 nerve root. Older patients undergoing multiple corpectomy are susceptible to these risks of palsy. Appropriate patient selection and sufficient additional foraminotomy should be considered for extensive anterior lesions and locally developed kyphosis to avoid postoperative C5 palsy.
术后C5麻痹是颈椎后路或前路减压术后一种众所周知的并发症。其病因在后路手术方面讨论得更多。主要假说是术后脊髓移位导致神经根牵拉和麻痹。然而，前路手术病例的发病机制尚未得到充分描述。因此，本研究的目的是通过我们的C5麻痹病例阐明前路手术中C5麻痹的危险因素。
149例患有颈椎前路病变的手术患者由同一位脊柱外科医生采用一致的相同治疗策略进行治疗。其中，88例符合评估标准的患者被纳入研究。术后C5麻痹定义为术后三角肌无力，伴或不伴有肱二头肌无力。从麻痹患者的临床背景、手术方式和影像学检查结果中提取C5麻痹的危险因素。
3例接受多次椎体次全切除术的患者中有4侧（4.6%）发生C5麻痹。所有麻痹均在术后数天出现并恢复。年龄较大、多次椎体次全切除术、术后脊髓移位以及C4-5和C5-6椎间孔狭窄经统计学分析被确定为C5麻痹的致病因素。在麻痹患者中，椎体次全切除术后观察到残留椎体骨赘导致前神经根扭曲以及脊髓向前移位。
对于前路病变较长且局部出现后凸畸形的患者，多次椎体次全切除术与术后较大的脊髓移位有关，这可能导致C5麻痹的发生。此外，C4-5或C5-6椎间孔狭窄可加速C5或C6神经根的束缚。接受多次椎体次全切除术的老年患者易患这些麻痹风险。对于广泛的前路病变和局部出现后凸畸形的情况，应考虑适当选择患者并进行充分的额外椎间孔切开术，以避免术后C5麻痹。
