Can prophylactic C4/5 foraminotomy prevent C5 palsy after cervical laminoplasty with and without posterior instrumented
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ORIGINAL ARTICLE
Can prophylactic C4/5 foraminotomy prevent C5 palsy after cervical laminoplasty with and without posterior instrumented fusion with maximal expansion? Yoshihito Yamasaki1 · Kazunari Takeuchi2 · Takuya Numasawa3 · Kanichiro Wada4 · Taito Itabashi5 · Gentaro Kumagai4 · Hitoshi Kudo4 · Sunao Tanaka4 · Toru Asari4 · Toru Yokoyama2 · Yasuyuki Ishibashi4 Received: 30 July 2020 / Accepted: 22 November 2020 © Springer-Verlag France SAS, part of Springer Nature 2020
Abstract Objective To prospectively examine whether laminoplasty with maximal expansion induces C5 palsy, even with prophylactic bilateral C4/5 foraminotomy. Methods Thirty-five consecutive patients with cervical myelopathy underwent laminoplasty (n = 19: LP group) or posterior decompression and fusion (n = 16: PDF group) with maximal expansion. Prophylactic bilateral C4/5 foraminotomy was performed alternately in consecutive five patients undergoing each type of surgery. In each type of surgery, the first and third consecutive five patients did not undergo foraminotomy (NF subgroup: 20 patients), while the second and fourth consecutive five patients underwent foraminotomy (F subgroup: 15 patients). The widths between the gutters was equivalent to the diameter of the spinal canal, and an inclination angle of the lamina of approximately 90° was created during laminoplasty. The incidence and severity of postoperative C5 palsy were investigated. Patients with a manual muscle testing score for the deltoid muscle and/or biceps brachii muscle of ≤ 2 were diagnosed with severe palsy. Results The respective incidences of C5 palsy in the F and NF subgroups were 33% and 20% in the LP group and 50% and 20% in the PDF group. Severe palsy occurred in 67% and 0% of patients who had developed palsy in F and NF subgroups, respectively, in the LP group, and in 100% of patients in the PDF group. Furthermore, 40% of the patients with severe palsy took more than 6 months to recover. Conclusions Laminoplasty with maximal expansion induced C5 palsy in both the LP and PDF groups, even with the addition of prophylactic bilateral C4/5 foraminotomy. Keywords C5 palsy · Prophylactic foraminotomy · Surgical outcome · Cervical posterior surgery · Cervical laminoplasty · Posterior shift of spinal cord
Introduction * Yoshihito Yamasaki [email protected] 1
Department of Orthopedic Surgery, Aomori City Hospital, 1‑14‑20, Katta, Aomori 030‑0821, Japan
2
Department of Orthopedic Surgery, Odate Municipal General Hospital, 3‑1 Yutaka‑cho, Odate, Akita 017‑0885, Japan
3
Department of Orthopedic Surgery, Hachinohe City Hospital, 3‑1‑1 Tamukai, Hachinohe, Aomori 031‑8555, Japan
4
Department of Orthopedic Surgery, Hirosaki University School of Medicine, 53 Hon‑cho, Hirosaki, Aomori 036‑8203, Japan
5
Department of Orthopedic Surgery, Towada City Hospital, 14‑8 nishijuunibann‑cho, Towada 034‑0093, Japan
Postoperative drop-arm syndrome, referred to as C5 palsy, is a common and serious complication of cervical laminoplasty (LP) and posterior decompr
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