Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Oct;7(7):696-702.
doi: 10.1177/2192568217699191. Epub 2017 Jun 1.

Why Does C5 Palsy Occur After Prophylactic Bilateral C4-5 Foraminotomy in Open-Door Cervical Laminoplasty? A Risk Factor Analysis

Gabriel Liu  1 , Ma Ramona Reyes  1 , K Daniel Riew  2
Affiliations

Why Does C5 Palsy Occur After Prophylactic Bilateral C4-5 Foraminotomy in Open-Door Cervical Laminoplasty? A Risk Factor Analysis

Gabriel Liu et al. Global Spine J. 2017 Oct.

Abstract

Study design: Retrospective study.

Objectives: To evaluate the efficacy of bilateral C4-5 foraminotomy in preventing occurrence of postoperative C5 palsy and to identify possible risk factors for its development.

Methods: A total of 70 consecutive patients who underwent open-door laminoplasty with bilateral C4-5 foraminotomy were included. Clinical, radiographic, and operative data was reviewed. Development of postoperative C5 palsy was analyzed.

Results: A total of 54 males and 16 females were reviewed. Mean age was 56 years (range, 30-86 years). The primary pathology was spondylosis in 76% of cases and ossified posterior longitudinal ligament in 21%. Radiographic evidence of C4-5 foraminal stenosis was seen in 81% of the patients. The mean duration of preoperative symptoms was 7 ± 19 months. Four (5.7%) out of 70 patients developed C5 palsy after open-door laminoplasty with bilateral C4-5 foraminotomy. Multivariate analysis showed that a long duration of preoperative symptoms (>12 months) and the presence of preoperative C4-5 T2-MRI cord signal change were statistically significant risk factors for the development of C5 palsy even after bilateral C4-5 foraminotomy in open-door laminoplasty (P < .0001 and P = .036, respectively).

Conclusions: Prophylactic bilateral C4-5 foraminotomies do not completely eliminate the occurrence of C5 palsy. Prolonged duration of symptoms and presence of preoperative T2-MRI cord signal change increase the risk for developing postoperative C5 palsy despite foraminotomy.

Keywords: C5 palsy; MRI cord signal change; cervical complications; cervical myelopathy; foraminotomy; open-door laminoplasty.

PubMed Disclaimer

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Interlaminar “V” junction where the cranial lamina intersects with the caudal one at the medial facet marks the start of the foraminal decompression.
Figure 2.
Figure 2.
Postoperative cervical radiographs showing bilateral C4-5 foraminotomy.
Figure 3.
Figure 3.
Sample case of a patient who developed C5 palsy after bilateral C4-6 foraminotomy.
Figure 4.
Figure 4.
Theories for the development of postoperative C5 palsy.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Kawaguchi Y, Kanamori M, Ishihara H, Ohmori K, Nakamura H, Kimura T. Minimum 10-year follow up after en bloc cervical laminoplasty. Clin Orthop Relat Res. 2003;(411):129–139. - PubMed
    1. Wada E, Suzuki S, Kanazawa A, Matsuoka T, Miyamoto S, Yonenobu K. Subtotal corpectomy versus laminoplasty for multilevel cervical spondylotic myelopathy: a long-term follow-up study over 10 years. Spine (Phila Pa 1976). 2001;26:1443–1448. - PubMed
    1. Sakaura H, Hosono N, Mukai Y, Ishii T, Yoshikawa H. C5 palsy after decompression surgery for cervical laminoplasty: review of literature. Spine (Phila Pa 1976). 2003;28:2447–2451. - PubMed
    1. Sakaura H, Hosono N, Mukai Y, Ishii T, Iwasaki M, Yoshikawa H. 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). 2005;30:756–759. - PubMed
    1. Wang YM, Shah S, Green BA. Clinical outcomes following cervical laminoplasty for 204 patients with cervical spondylotic myelopathy. Surg Neurol. 2004;6:2487–2493. - PubMed

LinkOut - more resources