Nakajima Hideaki, Honjoh Kazuya, Watanabe Shuji, Kubota Arisa, Matsumine Akihiko
Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences University of Fukui, Fukui, Japan.
Clin Spine Surg. 2022 Feb 1;35(1):E274-E279. doi: 10.1097/BSD.0000000000001187.
This was a retrospective study.
The objective of this study was to review clinical and imaging findings after anterior cervical decompression and fusion, as a basis for prevention of C5 palsy.
C5 palsy is a common postoperative complication in spine surgery, but the mechanistic basis for this condition is unknown.
The subjects were 239 patients with cervical myelopathy who underwent anterior cervical decompression and fusion including at C4-C5 disk level at our hospital from 2001 to 2018. Twelve of these patients (5.0%) had C5 palsy postoperatively. Clinical features and imaging findings were compared in patients with and without C5 palsy.
In patients with C5 palsy, the sagittal alignment of the cervical spine was kyphotic, the width of the C5 intervertebral foramen was narrower, and the lateral decompressed line was wider beyond the medial part of the Luschka joint. Age, sex, disease, the number of fused segments, decompression width, and anterior shift of the spinal cord did not differ significantly between patients with and without C5 palsy.
These results indicate that the pathomechanism of C5 palsy may be dependent on the location of the lateral decompression line, especially in patients with cervical kyphosis and a narrow C5 intervertebral foramen. Excessive lateral decompression beyond the Luchka joint might lead to C5 root kinking between the intervertebral foramen and posterior edge of vertebra. This pathomechanism may be similar in anterior and posterior approaches. To prevent C5 palsy, the medial line of the Luschka joint should be confirmed intraoperatively and decompression should be performed within the Luschka joints. Alternatively, medial foraminotomy should be used in cases needing wide decompression, such as those with massive ossification of the posterior longitudinal ligament, lateral osteophytes, and symptomatic foraminal stenosis.
Level III.
这是一项回顾性研究。
本研究的目的是回顾颈椎前路减压融合术后的临床和影像学表现，作为预防C5麻痹的依据。
C5麻痹是脊柱手术中常见的术后并发症，但这种情况的发病机制尚不清楚。
研究对象为2001年至2018年在我院接受颈椎前路减压融合术（包括C4-C5椎间盘水平）的239例颈椎病患者。其中12例患者（5.0%）术后出现C5麻痹。对有和没有C5麻痹的患者的临床特征和影像学表现进行了比较。
出现C5麻痹的患者中，颈椎矢状位呈后凸，C5椎间孔宽度变窄，外侧减压线在钩椎关节内侧部分以外更宽。有和没有C5麻痹的患者在年龄、性别、疾病、融合节段数、减压宽度和脊髓前移方面没有显著差异。
这些结果表明，C5麻痹的发病机制可能取决于外侧减压线的位置，特别是在颈椎后凸和C5椎间孔狭窄的患者中。钩椎关节外侧过度减压可能导致C5神经根在椎间孔和椎体后缘之间扭结。这种发病机制在前路和后路手术中可能相似。为预防C5麻痹，术中应确认钩椎关节的中线，并在钩椎关节内进行减压。或者，在需要广泛减压的情况下，如后纵韧带大量骨化、外侧骨赘和症状性椎间孔狭窄的患者中，应采用内侧椎间孔切开术。
三级。
