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Preventing C5 palsy after laminoplasty.

Kunihiko Sasai1, Takanori Saito, Shigeo Akagi

  • 1Department of Orthopaedic Surgery, Kansai Medical University, Osaka, Japan. sasaik@takii.kmu.ac.jp

Spine
|September 16, 2003
PubMed
Summary

Postoperative C5 palsy after cervical laminoplasty can be prevented. Preoperative electromyography (EMG) identifies patients at risk, allowing for selective foraminotomy to avoid this complication.

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Area of Science:

  • Neurosurgery
  • Spinal Surgery
  • Neurology

Background:

  • Cervical laminoplasty is a common procedure for cervical myelopathy.
  • Postoperative C5 palsy is a significant complication following cervical laminoplasty.
  • Predicting and preventing C5 palsy remains a challenge.

Purpose of the Study:

  • To investigate the causes, risk factors, and prevention strategies for C5 palsy after laminoplasty.
  • To compare the outcomes of a standardized diagnostic and surgical approach versus a standard laminoplasty technique.

Main Methods:

  • A prospective study comparing two groups of 111 patients undergoing laminoplasty for cervical myelopathy.
  • Group A received standardized diagnostic workup including electromyography (EMG) and tailored surgery (standard laminoplasty or modified laminoplasty with foraminotomy).

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  • Group B underwent standard midsagittal laminoplasty without preoperative EMG.

    • Main Results:

    • No patients in Group A developed postoperative C5 palsy, while three patients (8.1%) in Group B did (P = 0.035).
    • Preoperative EMG identified subclinical C5 root compression in patients who would later develop C5 palsy.
    • Selective foraminotomy in Group A was performed in 14.9% of patients with EMG abnormalities.

    Conclusions:

    • Electromyography is a sensitive predictor of postoperative C5 palsy following cervical laminoplasty.
    • Performing selective foraminotomy in patients with subclinical C5 root compression can prevent C5 palsy.
    • Preexisting subclinical C5 root compression is a primary cause of C5 palsy after posterior cervical decompression.