INFLUENCE OF CERVICAL SINGLE OPEN-DOOR LAMINOPLASTY WITH UNILATERAL C<sub>4,5</sub> FORAMINOTOMY ON C<sub>5</sub> PALSY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

MEGNDefu ^1,2 ,  SUNTianwei ² , TIANRong ² , ZHANGXueli ² , HUWei ² , JIAYutao ²

1. Graduate School of Tianjin Medical University, Tianjin, 300070, P. R. China;
2. Department of Spine Surgery, Tianjin Union Medicine Centre;

Corresponding?author：

SUNTianwei, Email: billsuntw@163.com

Keywords：

C₅ palsy; Cervical single open-door laminoplasty; Foraminotomy; Cervical myelopathy

DOI：

10.7507/1002-1892.20140105

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Objective To evaluate the effectiveness of cervical single open-door laminoplasty with the unilateral C_4,5 foraminotomy for cervical myelopathy in preventing postoperative C₅ palsy. Methods Between January 2008 and June 2012, 200 consecutive patients with cervical myelopathy and unilateral C_4,5 foraminal stenosis were treated, and the clinical data were retrospectively analyzed. Of them, 89 patients underwent cervical single open-door laminoplasty combined with unilateral C_4,5 foraminotomy (group A), and 111 patients underwent simple cervical single open-door laminoplasty (group B). There was no significant difference in gender, age, disease duration, segmental lesions, and diagnosis distribution between 2 groups (P>0.05). The operation time, intraoperative bleeding volume, and the incidence of C₅ palsy were recorded. The Japanese Orthopaedic Association (JOA) score before and after operation was used for neurological assessment, and the JOA recovery rate was calculated. Results The operation time was (122±29) minutes and the intraoperative bleeding volume was (165±50) mL in group A, which were significantly higher than those in group B[(109±31) minutes and (145±32) mL] (t=3.033, P=0.010;t=3.429, P=0.003). All patients were followed up; the follow-up time was 3-48 months (mean, 25 months) in group A, and was 4-50 months (mean, 27 months) in group B. C₅ palsy occurred in 1 patient of group A (1.12%), and in 9 patients of group B (8.11%), showing significant difference between 2 groups (χ²=3.709, P=0.045). The JOA score was significantly improved at 2 weeks and last follow-up after operation when compared with preoperative JOA scores in 2 groups (P<0.05), but no significant was found between at 2 weeks and at last follow-up (P>0.05) in each group. Between group A and group B, no significant difference was found in JOA score and the recovery rate (P>0.05). During follow-up, no persistent axial pain for a long time and obvious spinal instability occurred in 2 groups. Conclusion Cervical single open-door laminoplasty with unilateral C_4,5 foraminotomy can reduce the incidence of the C₅ palsy for patients with cervical myelopathy combined with unilateral C_4,5 foraminal stenosis.

Citation： MEGNDefu, SUNTianwei, TIANRong, ZHANGXueli, HUWei, JIAYutao. INFLUENCE OF CERVICAL SINGLE OPEN-DOOR LAMINOPLASTY WITH UNILATERAL C_4,5 FORAMINOTOMY ON C₅ PALSY. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(4): 463-467. doi: 10.7507/1002-1892.20140105 Copy

1.	王少波, 蔡欽林, 黨耕町, 等. 單開門頸椎管擴大術后第五頸神經根麻痹. 中華骨科雜志, 1999, 19(12):716-718.
2.	Stoops WL. Neural complication of cervical spondylosis:their response to laminectomy and foraminotomy. J Neurosurg, 1961, 19(7):986-999.
3.	Sakaura H, Hosono N, Mukai Y, et al. C₅ palsy after decompression surgery for cervical myelopathy:review of the literature. Spine (Phila Pa 1976), 2003, 28(21):2447-2451.
4.	Nakashima H, Imagama S, Yukawa Y, et al. Multivariate analysis of C-5 palsy incidence after cervical osterior fusion with instrumentation. Spine (Phila Pa 1976), 2012, 17(2):103-110.
5.	Sasai K, Saitoh T, Akagi S, et al. Prevention C₅ palsy after laminoplasty. Spine (Phila Pa 1976), 2003, 28(17):1972-1977.
6.	Chiba K, Toyama Y, Matsumoto M, et al. Segmental motor paralysis after expansive open-door laminoplasty. Spine (Phila Pa 1976), 2002, 27(19):2108-2115.
7.	Minoda Y, Nakamura H, Konishi S, et al. Palsy of the C₅ nerve root after midsagittal-splitting laminoplasty of the cervical spine. Spine (Phila Pa 1976), 2003, 28(11):1123-1127.
8.	孫天威, 張杭, 盧守亮, 等. 頸椎單開門椎管擴大成形術后鉸鏈側5神經根麻痹與不同椎板開門角度的臨床分析. 中國修復重建外科雜志, 2011, 25(11):1285-1289.
9.	Yonenobu K, Hosono N, Iwasaki M, et al. Neurologic complications of surgery for cervical compression myelopathy. Spine (Phila Pa 1976), 1991, 16(11):1277-1282.
10.	Hirabayashi K, Toyama Y, Chiba K. Expansive laminoplasty for myelopathy in ossification of the posterior longitudinal ligament. Clin Orthop Relat Res, 1999, (359):35-48.
11.	李君, 王新偉, 袁文, 等. 頸椎管成形術與椎板切除內固定術后C₅神經根麻痹比較. 中華骨科雜志, 2012, 32(5):415-419.
12.	Hasegawa K, Homma T, Chiba Y. Upper extremity palsy following cervical decompression surgery results from a transient spinal cord lesion. Spine (Phila Pa 1976), 2007, 32(6):E197-202.
13.	Hashimoto M, Mochizuki M, Aiba A, et al. C₅ palsy following anterior decompression and spinal fusion for cervical degenerative diseases. Eur Spine J, 2010, 19(10):1702-1710.
14.	Seichi A, Takeshita K, Kawaguchi H, et al. Postoperative expansion of intramedullary high-intensity areas on T₂-weighted magnetic resonance imaging after cervical laminoplasty. Spine (Phila Pa 1976), 2004, 29(13):1478-1482.
15.	Wu FL, Sun Y, Pan SF, et al. Risk factors associated with upper extremity palsy after expansive open-door laminoplasty for cervical myelopathy. Spine J, 2013.[Epub ahead of print].
16.	Imagama S, Matsuyama Y, Yukawa Y, et al. C₅ palsy after cervical laminoplasty-a multicentre study. J Bone Joint Surg (Br), 2010, 92(3):393-400.
17.	Katsumi K, Yamazaki A, Watanabe K, et al. Analysis of C₅ palsy after cervical open-door laminoplasty:relationship between C₅ palsy and foraminal stenosis. J Spinal Disord Tech, 2013, 26(4):177-182.
18.	Tsuzuki N, Abe R, Saiki K, et al. Paralysis of the arm after posterior decompression of the cervical spinal cord. Analyses of clinical findings. Eur Spine J, 1993, 2(4):197-202.
19.	Zhang J, Tsuzuki N, Hirabayashi S, et al. Surgical anatomy of the nerves and muscles in the posterior cervical spine:a guide for avoiding inadvertent nerve injures during the posterior approach. Spine (Phila Pa 1976), 2003, 28(13):1379-1384.
20.	Komagata M, Nishiyama M, Endo K, et al. Prophylaxis of C₅ palsy after cervical expansive laminoplasty by bilateral partial foraminotomy. Spine J, 2004, 4(6):650-655.
21.	Zdeblick TA, Abitbol JJ, Kunz DN, et al. Cervicalst ability after sequential capsule resection. Spine (Phila Pa 1976), 1993, 18(14):2005-2008.
22.	彭明, 戚超, 呂道靜, 等. 顯微內鏡下頸椎后路椎間孔切開減壓術的療效探討. 中國修復重建外科雜志, 2010, 24(5):513-516.

1. 王少波, 蔡欽林, 黨耕町, 等. 單開門頸椎管擴大術后第五頸神經根麻痹. 中華骨科雜志, 1999, 19(12):716-718.
2. Stoops WL. Neural complication of cervical spondylosis:their response to laminectomy and foraminotomy. J Neurosurg, 1961, 19(7):986-999.
3. Sakaura H, Hosono N, Mukai Y, et al. C₅ palsy after decompression surgery for cervical myelopathy:review of the literature. Spine (Phila Pa 1976), 2003, 28(21):2447-2451.
4. Nakashima H, Imagama S, Yukawa Y, et al. Multivariate analysis of C-5 palsy incidence after cervical osterior fusion with instrumentation. Spine (Phila Pa 1976), 2012, 17(2):103-110.
5. Sasai K, Saitoh T, Akagi S, et al. Prevention C₅ palsy after laminoplasty. Spine (Phila Pa 1976), 2003, 28(17):1972-1977.
6. Chiba K, Toyama Y, Matsumoto M, et al. Segmental motor paralysis after expansive open-door laminoplasty. Spine (Phila Pa 1976), 2002, 27(19):2108-2115.
7. Minoda Y, Nakamura H, Konishi S, et al. Palsy of the C₅ nerve root after midsagittal-splitting laminoplasty of the cervical spine. Spine (Phila Pa 1976), 2003, 28(11):1123-1127.
8. 孫天威, 張杭, 盧守亮, 等. 頸椎單開門椎管擴大成形術后鉸鏈側5神經根麻痹與不同椎板開門角度的臨床分析. 中國修復重建外科雜志, 2011, 25(11):1285-1289.
9. Yonenobu K, Hosono N, Iwasaki M, et al. Neurologic complications of surgery for cervical compression myelopathy. Spine (Phila Pa 1976), 1991, 16(11):1277-1282.
10. Hirabayashi K, Toyama Y, Chiba K. Expansive laminoplasty for myelopathy in ossification of the posterior longitudinal ligament. Clin Orthop Relat Res, 1999, (359):35-48.
11. 李君, 王新偉, 袁文, 等. 頸椎管成形術與椎板切除內固定術后C₅神經根麻痹比較. 中華骨科雜志, 2012, 32(5):415-419.
12. Hasegawa K, Homma T, Chiba Y. Upper extremity palsy following cervical decompression surgery results from a transient spinal cord lesion. Spine (Phila Pa 1976), 2007, 32(6):E197-202.
13. Hashimoto M, Mochizuki M, Aiba A, et al. C₅ palsy following anterior decompression and spinal fusion for cervical degenerative diseases. Eur Spine J, 2010, 19(10):1702-1710.
14. Seichi A, Takeshita K, Kawaguchi H, et al. Postoperative expansion of intramedullary high-intensity areas on T₂-weighted magnetic resonance imaging after cervical laminoplasty. Spine (Phila Pa 1976), 2004, 29(13):1478-1482.
15. Wu FL, Sun Y, Pan SF, et al. Risk factors associated with upper extremity palsy after expansive open-door laminoplasty for cervical myelopathy. Spine J, 2013.[Epub ahead of print].
16. Imagama S, Matsuyama Y, Yukawa Y, et al. C₅ palsy after cervical laminoplasty-a multicentre study. J Bone Joint Surg (Br), 2010, 92(3):393-400.
17. Katsumi K, Yamazaki A, Watanabe K, et al. Analysis of C₅ palsy after cervical open-door laminoplasty:relationship between C₅ palsy and foraminal stenosis. J Spinal Disord Tech, 2013, 26(4):177-182.
18. Tsuzuki N, Abe R, Saiki K, et al. Paralysis of the arm after posterior decompression of the cervical spinal cord. Analyses of clinical findings. Eur Spine J, 1993, 2(4):197-202.
19. Zhang J, Tsuzuki N, Hirabayashi S, et al. Surgical anatomy of the nerves and muscles in the posterior cervical spine:a guide for avoiding inadvertent nerve injures during the posterior approach. Spine (Phila Pa 1976), 2003, 28(13):1379-1384.
20. Komagata M, Nishiyama M, Endo K, et al. Prophylaxis of C₅ palsy after cervical expansive laminoplasty by bilateral partial foraminotomy. Spine J, 2004, 4(6):650-655.
21. Zdeblick TA, Abitbol JJ, Kunz DN, et al. Cervicalst ability after sequential capsule resection. Spine (Phila Pa 1976), 1993, 18(14):2005-2008.
22. 彭明, 戚超, 呂道靜, 等. 顯微內鏡下頸椎后路椎間孔切開減壓術的療效探討. 中國修復重建外科雜志, 2010, 24(5):513-516.

Chinese Journal of Reparative and Reconstructive Surgery

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INFLUENCE OF CERVICAL SINGLE OPEN-DOOR LAMINOPLASTY WITH UNILATERAL C_4,5 FORAMINOTOMY ON C₅ PALSY