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European Spine Journal

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01-12-2015 | Review Article

Prevalence of C5 nerve root palsy after cervical decompressive surgery: a meta-analysis

Authors: Fenyong Shou, Zhe Li, Huan Wang, Chongnan Yan, Qi Liu, Chi Xiao

Published in: European Spine Journal | Issue 12/2015

Abstract

Purpose

To investigate the epidemiological prevalence of C5 palsy in patients following cervical decompressive surgery.

Methods

We searched the PUBMED database for relevant studies that mentioned the incidence of C5 palsy after cervical surgery. We also manually screened reference lists for additional qualified articles. Relevant prevalence estimates were calculated by an appropriate meta-analysis. Subgroup analysis, sensitivity analysis, and publication bias assessment were also performed, respectively.

Results

Finally, a total of 79 studies, with 704 C5 palsy cases in 13,621 patients, were included in our meta-analysis. The overall pooled prevalence of C5 palsy was 5.3 % (95 % CI 4.6–6.0 %). Individuals after posterior cervical surgery (5.8 %) had a slightly higher prevalence than those after anterior surgery (5.2 %), and a similar trend was observed between ossification of posterior longitudinal ligament (OPLL) (5.8 %) and cervical spondylotic myelopathy (CSM) (4.5 %). The highest prevalence (11.0 %) was found in patients who underwent laminectomy and fusion (LIF), while those who received anterior cervical discectomy and fusion (ACDF) had the lowest prevalence (3.3 %). Other intermediate prevalence estimates increased gradually, from cervical laminoplasty-only (CLP-only) (5.1 %), to CLP plus other posterior procedures (6.5 %) and anterior cervical corpectomy and fusion (ACCF) (7.5 %). The prevalence was significantly higher in male (5.2 %) than in female (2.2 %) patients. In most cases, C5 palsy was unilateral and transient, and diagnosed within 3 days (3.4 %).

Conclusion

Cervical surgery is associated with high risk of C5 palsy, particularly in patients who received LIF and in male patients. These figures may be useful in the estimation of the probability of C5 palsy following cervical surgery.

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Scoville WB (1961) Cervical spondylosis treated by bilateral facetectomy and laminectomy. J Neurosurg 18:423–428CrossRefPubMed

Sakaura H, Hosono N, Mukai Y et al (2003) C5 palsy after decompression surgery for cervical myelopathy. Spine 28:2447–2451CrossRefPubMed

Chang PY, Chan RC, Tsai YA et al (2013) Quantitative measures of functional outcomes and quality of life in patients with C5 palsy. J Chin Med Assoc 76:378–384CrossRefPubMed

Ikenaga M, Shikata J, Tanaka C (2005) Radiculopathy of C-5 after anterior decompression for cervical myelopathy. J Neurosurg Spine 3:210–217CrossRefPubMed

Hashimoto M, Mochizuki M, Aiba A et al (2010) C5 palsy following anterior decompression and spinal fusion for cervical degenerative diseases. Eur Spine J 19:1702–1710PubMedCentralCrossRefPubMed

Nassr A, Eck JC, Ponnappan RK et al (2012) The incidence of C5 palsy after multilevel cervical decompression procedures: a review of 750 consecutive cases. Spine (Phila Pa 1976) 37:174–178CrossRef

Shibuya S, Komatsubara S, Oka S et al (2010) Differences between subtotal corpectomy and laminoplasty for cervical spondylotic myelopathy. Spinal Cord 48:214–220CrossRefPubMed

Lin QS, Zhou XH, Wang XW et al (2012) A comparison of anterior cervical discectomy and corpectomy in patients with multilevel cervical spondylotic myelopathy. Eur Spine J 21:474–481PubMedCentralCrossRefPubMed

Lubelski D, Derakhshan A, Nowacki AS et al (2014) Predicting C5 palsy via the use of preoperative anatomic measurements. Spine J 14:1895–1901CrossRefPubMed

10.

Shaikh N, Morone NE, Bost JE et al (2008) Prevalence of urinary tract infection in childhood—a meta-analysis. Pediatr Infect Dis J 27:302–308CrossRefPubMed

11.

Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21:1539–1558CrossRefPubMed

12.

Huedo-Medina TB, Sánchez-Meca J, Marín-Martínez F et al (2006) Assessing heterogeneity in meta-analysis: Q statistic or I² index? Psychol Methods 11:193–206CrossRefPubMed

13.

Trikalinos TA, Salanti G, Zintzaras E et al (2008) Meta-analysis methods. Adv Genet 60:311–334CrossRefPubMed

14.

Egger M, Davey SG, Schneider M et al (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315:629–634PubMedCentralCrossRefPubMed

15.

Shinomiya K, Kurosa Y, Fuchioka M et al (1989) Clinical study of dissociated motor weakness following anterior cervical decompression surgery. Spine (Phila Pa 1976) 14:1211–1214CrossRef

16.

Yonenobu K, Hosono N, Iwasaki M et al (1991) Neurologic complications of surgery for cervical compression myelopathy. Spine (Phila Pa 1976) 16:1277–1282CrossRef

17.

Tsuzuki N, Abe R, Saiki K et al (1993) Paralysis of the arm after posterior decompression of the cervical spinal cord. II. Analyses of clinical findings. Eur Spine J 2:197–202CrossRefPubMed

18.

Satomi K, Nishu Y, Kohno T et al (1994) Long-term follow-up studies of open-door expansive laminoplasty for cervical stenotic myelopathy. Spine (Phila Pa 1976) 19:507–510CrossRef

19.

Saunders RL (1995) On the pathogenesis of the radiculopathy complicating multilevel corpectomy. Neurosurgery 37:408–412 (discussion 412–413)CrossRefPubMed

20.

Tsuzuki N, Abe R, Saiki K et al (1996) Extradural tethering effect as one mechanism of radiculopathy complicating posterior decompression of the cervical spinal cord. Spine (Phila Pa 1976) 21:203–211CrossRef

21.

Dai LY, Ni B, Yuan W et al (1998) Radiculopathy after laminectomy for cervical compression myelopathy. J Bone Joint Surg Br 80:846–849CrossRefPubMed

22.

Uematsu Y, Tokuhashi Y, Matsuzaki H (1998) Radiculopathy after laminoplasty of the cervical spine. Spine (Phila Pa 1976) 23:2057–2062CrossRef

23.

Edwards CC 2nd, Heller JG, Silcox DH 3rd (2000) T-Saw laminoplasty for the management of cervical spondylotic myelopathy: clinical and radiographic outcome. Spine (Phila Pa 1976) 25:1788–1794CrossRef

24.

Epstein N (2001) Anterior approaches to cervical spondylosis and ossification of the posterior longitudinal ligament: review of operative technique and assessment of 65 multilevel circumferential procedures. Surg Neurol 55:313–324CrossRefPubMed

25.

Bose B (2001) Anterior cervical instrumentation enhances fusion rates in multilevel reconstruction in smokers. J Spinal Disord 14:3–9CrossRefPubMed

26.

Wada E, Suzuki S, Kanazawa A et al (2001) Subtotal corpectomy versus laminoplasty for multilevel cervical spondylotic myelopathy-a long-term follow-up study over 10 years. Spine (Phila Pa 1976) 26:1443–1447 (discussion 1448)CrossRef

27.

Fan D, Schwartz DM, Vaccaro AR et al (2002) Intraoperative neurophysiologic detection of iatrogenic C5 nerve root injury during laminectomy for cervical compression myelopathy. Spine (Phila Pa 1976) 27:2499–2502CrossRef

28.

Fujimoto Y, Baba I, Sumida T et al (2002) Microsurgical transdural discectomy with laminoplasty: new treatment for paracentral and paracentroforaminal cervical disc herniation associated with spinal canal stenosis. Spine (Phila Pa 1976) 27:715–721CrossRef

29.

Chiba K, Toyama Y, Matsumoto M et al (2002) Segmental motor paralysis after expansive open-door laminoplasty. Spine (Phila Pa 1976) 27:2108–2115CrossRef

30.

Huang RC, Girardi FP, Poynton AR et al (2003) Treatment of multilevel cervical spondylotic myeloradiculopathy with posterior decompression and fusion with lateral mass plate fixation and local bone graft. J Spinal Disord Tech 16:123–129CrossRefPubMed

31.

Minoda Y, Nakamura H, Konishi S et al (2003) Palsy of the C5 nerve root after midsagittal-splitting laminoplasty of the cervical spine. Spine (Phila Pa 1976) 28:1123–1127

32.

Sasai K, Saito T, Akagi S et al (2003) Preventing C5 palsy after laminoplasty. Spine (Phila Pa 1976) 28:1972–1977CrossRef

33.

Seichi A, Takeshita K, Kawaguchi H et al (2004) Postoperative expansion of intramedullary high-intensity areas on T2-weighted magnetic resonance imaging after cervical laminoplasty. Spine (Phila Pa 1976) 29:1478–1482 (discussion 1482)CrossRef

34.

Komagata M, Nishiyama M, Endo K et al (2004) Prophylaxis of C5 palsy after cervical expansive laminoplasty by bilateral partial foraminotomy. Spine J 4:650–655CrossRefPubMed

35.

Sakaura H, Hosono N, Mukai Y et al (2005) Long-term outcome of laminoplasty for cervical myelopathy due to disc herniation: a comparative study of laminoplasty and anterior spinal fusion. Spine (Phila Pa 1976) 30:756–759CrossRef

36.

Kaneko K, Hashiguchi A, Kato Y et al (2006) Investigation of motor dominant C5 paralysis after laminoplasty from the results of evoked spinal cord responses. J Spinal Disord Tech 19:358–361CrossRefPubMed

37.

Tanaka N, Nakanishi K, Fujiwara Y et al (2006) Postoperative segmental C5 palsy after cervical laminoplasty may occur without intraoperative nerve injury: a prospective study with transcranial electric motor-evoked potentials. Spine (Phila Pa 1976) 31:3013–3017CrossRef

38.

Bose B, Sestokas AK, Schwartz DM (2007) Neurophysiological detection of iatrogenic C-5 nerve deficit during anterior cervical spinal surgery. J Neurosurg Spine 6:381–385CrossRefPubMed

39.

Chen Y, Chen D, Wang X et al (2007) C5 palsy after laminectomy and posterior cervical fixation for ossification of posterior longitudinal ligament. J Spinal Disord Tech 20:533–535CrossRefPubMed

40.

Hasegawa K, Homma T, Chiba Y (2007) Upper extremity palsy following cervical decompression surgery results from a transient spinal cord lesion. Spine (Phila Pa 1976) 32:E197–E202CrossRef

41.

Takemitsu M, Cheung KM, Wong YW et al (2008) C5 nerve root palsy after cervical laminoplasty and posterior fusion with instrumentation. J Spinal Disord Tech 21:267–272CrossRefPubMed

42.

Shiozaki T, Otsuka H, Nakata Y et al (2009) Spinal cord shift on magnetic resonance imaging at 24 hours after cervical laminoplasty. Spine (Phila Pa 1976) 34:274–279CrossRef

43.

Kaner T, Sasani M, Oktenoğlu T et al (2009) Clinical outcomes following cervical laminoplasty for 19 patients with cervical spondylotic myelopathy. Turk Neurosurg 19:121–126PubMed

44.

Minamide A, Yoshida M, Yamada H et al (2010) Clinical outcomes of microendoscopic decompression surgery for cervical myelopathy. Eur Spine J 19:487–493PubMedCentralCrossRefPubMed

45.

Imagama S, Matsuyama Y, Yukawa Y et al (2010) C5 palsy after cervical laminoplasty: a multicentre study. J Bone Joint Surg Br 92:393–400CrossRefPubMed

46.

Dalbayrak S, Yilmaz M, Naderi S (2010) Skip corpectomy in the treatment of multilevel cervical spondylotic myelopathy and ossified posterior longitudinal ligament. J Neurosurg Spine 12:33–38CrossRefPubMed

47.

Yanase M, Matsuyama Y, Mori K et al (2010) Intraoperative spinal cord monitoring of C5 palsy after cervical laminoplasty. J Spinal Disord Tech 23:170–175CrossRefPubMed

48.

Liu TL, Zou WW, Han Y et al (2010) Correlative study of nerve root palsy and cervical posterior decompression laminectomy and internal fixation. Orthopedics. doi:10.3928/01477447-20100625-08

49.

Kaneyama S, Sumi M, Kanatani T et al (2010) Prospective study and multivariate analysis of the incidence of C5 palsy after cervical laminoplasty. Spine (Phila Pa 1976) 35:E1553–E1558CrossRef

50.

Campbell PG, Yadla S, Malone J et al (2010) Early complications related to approach in cervical spine surgery: single-center prospective study. World Neurosurg 74:363–368CrossRefPubMed

51.

Guo QF, Ni B, Zhou FJ et al (2011) Anterior hybrid decompression and segmental fixation for adjacent three-level cervical spondylosis. Arch Orthop Trauma Surg 131:631–636CrossRefPubMed

52.

Xia YP, Xia YY, Shen QF et al (2011) Influence of hinge position on the effectiveness of expansive open-door laminoplasty for cervical spondylotic myelopathy. J Spinal Disord Tech 24:514–520PubMed

53.

Katonis P, Papadakis SA, Galanakos S et al (2011) Lateral mass screw complications—analysis of 1662 screws. J Spinal Disord Tech 24:415–420CrossRefPubMed

54.

Chen Y, Guo YF, Lu XH et al (2011) Surgical strategy for multilevel severe ossification of posterior longitudinal ligament in the cervical spine. J Spinal Disord Tech 24:24–30CrossRefPubMed

55.

Kim K, Isu T, Sugawara A et al (2011) Selective posterior decompression of the cervical spine. Neurol Med Chir (Tokyo) 51:108–112CrossRef

56.

Xia G, Tian R, Xu TT et al (2011) Spinal posterior movement after posterior cervical decompression surgery: clinical findings and factors affecting postoperative functional recovery. Orthopedics 34:e911–e918PubMed

57.

Kotil K, Tari R (2011) Two level cervical corpectomy with iliac crest fusion and rigid plate fixation: a retrospective study with a three-year follow-up. Turk Neurosurg 21:606–612PubMed

58.

Xu R, Bydon M, Sciubba DM et al (2011) Safety and efficacy of rhBMP2 in posterior cervical spinal fusion for subaxial degenerative spine disease: analysis of outcomes in 204 patients. Surg Neurol Int 2:109PubMedCentralCrossRefPubMed

59.

Zhao XT, Xue Y, Pan FL et al (2012) Extensive laminectomy for the treatment of ossification of the posterior longitudinal ligament in the cervical spine. Arch Orthop Trauma Surg 132:203–209CrossRefPubMed

60.

Chen Y, Chen DY, Wang XW et al (2012) Single-stage combined decompression for patients with tandem ossification in the cervical and thoracic spine. Arch Orthop Trauma Surg 132:1219–1226CrossRefPubMed

61.

Liu Y, Qi M, Chen HJ et al (2012) Comparative analysis of complications of different reconstructive techniques following anterior decompression for multilevel cervical spondylotic myelopathy. Eur Spine J 21:2428–2435PubMedCentralCrossRefPubMed

62.

Eskander MS, Balsis SM, Balinger C et al (2012) The association between preoperative spinal cord rotation and postoperative C5 nerve palsy. J Bone Joint Surg Am 94:1605–1609CrossRefPubMed

63.

Nakashima H, Imagama S, Yukawa Y et al (2012) Multivariate analysis of C-5 palsy incidence after cervical posterior fusion with instrumentation. J Neurosurg Spine 17:103–110CrossRefPubMed

64.

Zhang H, Lu SL, Sun TW et al (2015) Effect of lamina open angles in expansion open-door laminoplasty on the clinical results in treating cervical spondylotic myelopathy. J Spinal Disord Tech 28:89–94CrossRefPubMed

65.

Kim SJ, Lee SH, Kim ES et al (2014) Clinical and Radiographic Analysis of C5 palsy after Anterior Cervical Decompression and Fusion for Cervical Degenerative Disease. J Spinal Disord Tech 27:436–441CrossRefPubMed

66.

Nakamae T, Tanaka N, Nakanishi K et al (2012) Investigation of segmental motor paralysis after cervical laminoplasty using intraoperative spinal cord monitoring with transcranial electric motor-evoked potentials. J Spinal Disord Tech 25:92–98CrossRefPubMed

67.

Park JH, Roh SW, Rhim SC et al (2012) Long-term outcomes of 2 cervical laminoplasty methods: midline splitting versus unilateral single door. J Spinal Disord Tech 25:E224–E229CrossRefPubMed

68.

Chen GD, Luo ZP, Nalajala B et al (2012) Expansive open-door laminoplasty with titanium miniplate versus sutures. Orthopedics 35:e543–e548CrossRefPubMed

69.

Chen Y, Liu XW, Chen DY et al (2012) Surgical strategy for ossification of the posterior longitudinal ligament in the cervical spine. Orthopedics 35:e1231–e1237CrossRefPubMed

70.

Katsumi K, Yamazaki A, Watanabe K et al (2012) Can prophylactic bilateral C4/C5 foraminotomy prevent postoperative C5 palsy after open-door laminoplasty?: a prospective study. Spine (Phila Pa 1976) 37:748–754CrossRef

71.

Chen Y, Chen DY, Wang XW et al (2013) Significance of segmental instability in cervical ossification of the posterior longitudinal ligament and treated by a posterior hybrid technique. Arch Orthop Trauma Surg 133:171–177CrossRefPubMed

72.

Liu K, Shi JG, Jia LS et al (2013) Surgical technique: hemilaminectomy and unilateral lateral mass fixation for cervical ossification of the posterior longitudinal ligament. Clin Orthop Relat Res 471:2219–2224PubMedCentralCrossRefPubMed

73.

Katsumi K, Yamazaki A, Watanabe K et al (2013) Analysis of C5 palsy after cervical open-door laminoplasty: relationship between C5 palsy and foraminal stenosis. J Spinal Disord Tech 26:177–182CrossRefPubMed

74.

Odate S, Shikata J, Kimura H et al (2013) Hybrid decompression and fixation technique versus plated three-vertebra corpectomy for four-segment cervical myelopathy: analysis of 81 cases with a minimum 2-year follow-up. J Spinal Disord Tech (epub ahead of print)

75.

Lee SE, Chung CK, Kim CH et al (2013) Symmetrically medial bony gutters for open-door laminoplasty. J Spinal Disord Tech 26:E101–E106CrossRefPubMed

76.

Yang LL, Gu YF, Shi JQ et al (2013) Modified plate-only open-door laminoplasty versus laminectomy and fusion for the treatment of cervical stenotic myelopathy. Orthopedics 36:e79–e87CrossRefPubMed

77.

Odate S, Shikata J, Yamamura S et al (2013) Extremely wide and asymmetric anterior decompression causes postoperative C5 palsy: an analysis of 32 patients with postoperative C5 palsy after anterior cervical decompression and fusion. Spine (Phila Pa 1976) 38:2184–2189CrossRef

78.

Choi KC, Ahn Y, Kang BU et al (2013) Motor palsy after posterior cervical foraminotomy: anatomical consideration. World Neurosurg 79:405.e1–405.e4CrossRef

79.

Kanchiku T, Imajo Y, Suzuki H et al (2014) Results of surgical treatment of cervical spondylotic myelopathy in patients aged 75 years or more: a comparative study of operative methods. Arch Orthop Trauma Surg 134:1045–1050CrossRefPubMed

80.

Chen Y, Wang XW, Chen DY et al (2014) Posterior hybrid technique for ossification of the posterior longitudinal ligament associated with segmental instability in the cervical spine. J Spinal Disord Tech 27:240–244CrossRefPubMed

81.

Ohashi M, Yamazaki A, Watanabe K et al (2014) Two-year clinical and radiological outcomes of open-door cervical laminoplasty with prophylactic bilateral C4-C5 foraminotomy in a prospective study. Spine (Phila Pa 1976) 39:721–727CrossRef

82.

Miller JA, Lubelski D, Alvin MD et al (2014) C5 palsy after posterior cervical decompression and fusion: cost and quality-of-life implications. Spine J 14:2854–2860CrossRefPubMed

83.

Du W, Zhang P, Shen Y et al (2014) Enlarged laminectomy and lateral mass screw fixation for multilevel cervical degenerative myelopathy associated with kyphosis. Spine J 14:57–64CrossRefPubMed

84.

Wu FL, Sun Y, Pan SF et al (2014) Risk factors associated with upper extremity palsy after expansive open-door laminoplasty for cervical myelopathy. Spine J 14:909–915CrossRefPubMed

85.

Satomi K, Ogawa J, Ishii Y et al (2001) Short-term complications and long-term results of expansive open-door laminoplasty for cervical stenotic myelopathy. Spine J 1:26–30CrossRefPubMed

86.

Chen J, Wang XW, Bai WS et al (2012) Prevalence of heterotopic ossification after cervical total disc arthroplasty: a meta-analysis. Eur Spine J 21:674–680PubMedCentralCrossRefPubMed

87.

Sharma S, Wu CS, Andersen T et al (2013) Prevalence of complications in neuromuscular scoliosis surgery:a literature meta-analysis from the past 15 years. Eur Spine J 22:1230–1249PubMedCentralCrossRefPubMed

88.

Xia XP, Chen HL, Cheng HB (2013) Prevalence of adjacent segment degeneration after spine surgery: a systematic review and meta-analysis. Spine (Phila Pa 1976) 38:597–608CrossRef

89.

Guzman JZ, Baird EO, Fields AC et al (2014) C5 nerve root palsy following decompression of the cervical spine: a systematic evaluation of the literature. Bone Joint J 96-B:950–955CrossRefPubMed

90.

Gu YF, Cao P, Gao R et al (2014) Incidence and risk factors of C5 palsy following posterior cervical decompression: a systematic review. PLoS One 9:e101933PubMedCentralCrossRefPubMed

Title: Prevalence of C5 nerve root palsy after cervical decompressive surgery: a meta-analysis
Authors: Fenyong Shou
Zhe Li
Huan Wang
Chongnan Yan
Qi Liu
Chi Xiao
Publication date: 01-12-2015
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue 12/2015
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-015-4186-5

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Prevalence of C5 nerve root palsy after cervical decompressive surgery: a meta-analysis

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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