Relationship between different cervical curvature and spinal cord posterior movement after laminectomy with lateral mass screw fixation and its influence on the operative effect / 中国综合临床

Objective@#To investigate the relationship between cervical curvature (CC) and spinal drift distance after laminectomy with lateral mass screw fixation and the influence on the operative effect.@*Methods@#From October 2016 to December 2017, a total of 85 patients with cervical spondylotic myelopathy (CSM) underwent laminectomy with lateral mass screw fixation in handan central hospital, and 78 patients were followed up completely.After the operation, according to the Harrison method, they were divided into 2 groups(Group A (43 cases, 0°≤CC≤16.5°); Group B (35 cases, CC>16.5°)). The spinal drift distance, nerve recovery, axial symptoms and C5 palsy in the groups were recorded and analyzed.@*Results@#The CC was 8.5°±3.8° in group A and 19.6°±3.0° in group B (t=14.071, P=0.000). The laminectomy width in group A was (22.1±1.7) mm, in group B was (21.8±1.5) mm, the difference between the two groups was not statistically significant (P>0.05). The distance of spinal cord backward movement was (1.7±0.4) mm in group A and (3.2±0.7) mm in group B. There was significant difference between the two groups (t=11.879, P<0.001). At the end of one year, the improvement rates of nerve function in the two groups were (63.3±13.1)% and (65.1±13.9)% respectively, there was no significant difference between the two groups (t=0.587, P=0.559). The VAS score of group A was (5.2±1.3) at one week and (3.5±0.6) at one month after operation, and that of group B was (3.8±0.8) and (2.4±0.4) respectively.There were statistically significant differences between groups at different time points (t=5.567, P<0.001; t=9.289, P<0.001). The incidence of C5 paralysis was 7.0% (3/43) in group A and 11.4% (4/35) in group B. There was no significant difference between the two groups (P>0.05).@*Conclusion@#The greater the curvature of cervical spine is, the more fully the spinal cord moves backward.The loss of curvature of cervical spine is related to the occurrence of axial symptoms.The curvature of cervical spine is not related to the recovery of nerve function and the occurrence of C5 nerve paralysis.

Relationship between Cervical Curvature and Spinal Drift Distance after Laminectomy with Screw Fixation and Its Effect on Clinical Outcome / 中国康复理论与实践

Objective:To observe the relationship between cervical curvature and spinal drift distance after laminectomy with lateral mass screw fixation, and its effect on clinical outcome. Methods:From January, 2017 to October, 2018, a total of 117 patients with cervical spondylotic myelopathy (CSM) underwent laminectomy with lateral mass screw fixation, and 90 of them completed the follow-up. According to the patients' cervical curvature (CC), they were divided into three groups: those CC between 0° to 5° were in Group A (n = 28), 5° to 16.5° in Group B (n = 36) and CC > 16.5° in Group C (n = 26). The spinal drift distance, nerve recovery, axial symptoms and C5 palsy were recorded and analyzed. Results:There were significant differences in CC and spinal drift distance (F > 152.119,P < 0.001), and no significant difference was found in laminectomy width and incidence of C5 palsy (P > 0.05) among three groups. The Japanese Orthopaedic Association (JOA) score significantly increased in all the groups post operation and at the last follow-up (t > 8.869,P < 0.001), and no significant difference was found among there groups at the same time (P > 0.05), as well as the incidence of C5 palsy (F = 0.472,P = 0.625). There was significant difference in the score of Visual Analogue Scale of axial symptoms among three groups (F > 34.800,P < 0.001), which was lower in groups B and C than in group A (t > 5.845,P< 0.001), and no significant differene was found between group B and group C. Conclusion:On the basis of the same laminectomy width, the greater the CC was, the more favorable the spinal drift went backwards. The loss of CC was related to the occurrence of axial symptoms, but was not correlated with the neurological recovery and C5 palsy.

Effect of Limited Laminectomy Combined with Foraminal Stenosis Decompression on Preventing C5Palsy / 中国康复理论与实践

@#Objective To observe the effect of limited laminectomy combined with foraminal stenosis decompression on preventing C5nerve root palsy and improving neurological function. Methods From March,2014 to May,2016,69 patients with multi-segment cervical spondylotic myelopathy underwent surgical treatment in our hospital were included.Thirty-eight patients(group A)were treated with limited lami-nectomy combined with foraminal stenosis decompression and internal fixation,and 31 patients(group B)under-went routine laminectomy and internal fixation.The postoperative neurological recovery rate,cervical curvature index(CCI)and C5palsy rate were recorded and analyzed. Results No spinal cord and nerve injury occurred during the operation.The width of laminectomy was(16.8±2.1)mm in group A,and was significantly less than(21.7±2.5)mm in group B(t=8.849,P<0.001).There was no significant difference in operation time and intraoperative blood loss between two groups(t<0.439,P>0.05).The Japanese Orthopaedic Association (JOA) score increased continuously after surgery in both groups (F>42.996, P<0.05), and no significant difference was found between them at each time point(t<1.021,P>0.05).The cervical curva-ture index improved after surgery(F>86.379,P<0.05),and no significant difference was found between them at each time point(t<0.943,P>0.05).The spinal cord drift distance was(3.6±0.7)mm in group A,and ws signifi-cantly shorter than(2.5±0.5)mm in group B(t=7.602,P<0.001).There was no significantly difference in the neu-rological recovery rate between two groups(t=0.724,P=0.471).The C5palsy rate was lower in group A(5.2%,2/38)than in group B(22.5%,7/31)(χ2=4.514,P=0.034). Conclusion Limited laminectomy combined with foraminal stenosis decompression could relieve the spinal cord com-pression and restrict the excessive back drift, promote the neurological function recovery and reduce the inci-dence of C5palsy.

Analysis of C5 palsy with C4/5 foraminotomy after posterior cervical decompression surgery / 天津医药

Objective To evaluate the effects of C4-5 partial foraminotomy on reducing the occurrence of C5 palsy after posterior cervical decompression surgery. Methods A total of 127 patients (male 62, female 65) underwent the cervical decompression surgery with lateral cervical mass screw insertion between January 2011 and December 2015 were retrospectively analyzed. In these patients sixty-one cases (Group A) underwent the posterior laminectomy with lateral cervical mass screw insertion, while 66 cases (Group B) received posterior laminectomy with lateral cervical mass screw insertion, combined with partial C4/5 foraminotomy at C4-5 level. The clinical data, radiographic parameters and the occurrence of C5 palsy were assessed in two groups of patients. Results There was no significant difference in JOA recovery rate and change of cervical curvature index between preoperation and postoperation in each group (P>0.05). Postoperative C5 palsy occurred in 11 cases (18.03%) in group A and 3 cases (4.05%) in group B. The difference in the incidence of C5 palsy was significant between the two groups (P=0.022). Conclusion The cervical decompression surgery can improve the function of the spinal cord effectively. C4-5 partial foraminotomy after cervical decompression surgery is effective for preventing C5 palsy.

Risk Factor Analysis for C5 Palsy after Double-Door Laminoplasty for Cervical Spondylotic Myelopathy

STUDY DESIGN: A retrospective comparative study. PURPOSE: To clarify the risk factors related to the development of postoperative C5 palsy through radiological studies after cervical double-door laminoplasty (DDL). OVERVIEW OF LITERATURE: Although postoperative C5 palsy is generally considered to be the result of damage to the nerve root or segmental spinal cord, the associated pathology remains controversial. METHODS: A consecutive case series of 47 patients with cervical spondylotic myelopathy treated by DDL at our institution between April 2008 and April 2015 were reviewed. Postoperative C5 palsy occurred in 5 of 47 cases after DDL. We investigated 9 radiologic factors that have been reported to be risk factors for C5 palsy in various studies, and statistically examined these between the two groups of palsy and the non-palsy patients. RESULTS: We found a significant difference between patients with and without postoperative C5 palsy with regards to the posterior shift of spinal cord at C4/5 (p=0.008). The logistic regression analyses revealed posterior shift of the spinal cord at C4/5 (odds ratio, 12.066; p=0.029; 95% confidence interval, 1.295–112.378). For the other radiologic factors, there were no statistically significant differences between the two groups. CONCLUSIONS: In the present study, we showed a significant difference in the posterior shift of the spinal cord at C4/5 between the palsy and the non-palsy groups, indicating that the "tethering phenomenon" was likely a greater risk factor for postoperative C5 palsy.

Relation of spinal shifting and C5 palsy after cervical decompression surgery / 国际外科学杂志

Objective To study the relationship between spinal shifting and C5 palsy after posterior approach cervical decompression surgery (PACDS).Methods Twenty-four patients underwent PACDS were examined with MRI before and one month after operation.The spinal shifting were measured.Clinical and imaging characteristics of patients with post-operative C5 palsy were observed.Analyzed the correlation between C5 palsy and spinal shifting after operation.Results The average spinal shifting was (2.41 ± 0.46) mm.Three cases developed C5 palsy,whose spinal shifting at C5 level was significantly greatert han those without C5 palsy.Conclusion Excessive posterior spinal shifting after PACDS can drag C5 nerve root leading to C5 palsy.