2012년 10월 7일 일요일

The Incidence of C5 Palsy After Multilevel Cervical Decompression Procedures A review of 750 consecutive cases

Cervical Spine
Spine 2012;37:174–178

Title:
The Incidence of C5 Palsy After Multilevel Cervical Decompression Procedures
A Review of 750 consecutive cases

Authors
Ahmad Nassr
Jason C. Eck
Ravi K. Ponnappan
Rami R. Zanoun
William F. Donaldson III
James D. Kang

Study Design.
Retrospective review of consecutive multilevel cervical spine decompression surgeries performed by a single spine surgeon

Objective.
To determine the incidence of C5 palsy in a large consecutive series of multilevel cervical spine decompression procedures

Summary of Background Data.
1. Palsy of the C5 nerve is a well-known potential complication of cervical spine surgery

2. Complication rates: 0% ~ 30%.

3. The etiology remains uncertain, but attributed to iatrogenic injury during surgery, tethering from shifting of the spinal cord, spinal cord ischemia, and reperfusion injury of the spinal cord.

Methods.
1. Inclusion Criteria
   * Multilevel cervical corpectomy
   * Corpectomy with posterior fusion
   * Posterior laminectomy and fusion
   * Laminoplasty

2. Exclusion criteria
* Lack of follow-up data
* Spinal cord injury preventing preoperative or postoperative motor testing, or surgery not involving the C5 level.

3. C5 palsy incidence was determined and compared to determine whether significant differences existed among the various procedures, patient age, sex, revision surgery, preoperative weakness, diabetes, smoking, number of levels decompressed, and history of previous upper extremity surgery.

Results.
1. 750 – 120, total 630 patients (F: 292, M: 338/ mean age: 58, 19~87)

2. C5 nerve palsy incidence (all group): 42 of 630 (6.7%)

3. Incidence
* Laminectomy and fusion group (9.5%)
* Corpectomy with posterior fusion group (8.4%)
* Corpectomy group (5.1%)
* Laminoplasty group (4.8%)
# No statistical significance

4. Significantly higher incidence in males (8.6% vs. 4.5%, P = 0.05)

Conclusion.
1. C5 nerve palsy incidence after cervical spine decompression was 6.7% (consistent with previous studies) with an increased risk in male patients

2. No statistically significant difference in incidence of C5 palsy based on surgical procedures

3. But there was a trend toward higher rates with laminectomy and fusion.

4. Patients should be counseled that 19% of those who develop C5 palsy have some residual deficits, but over 70% recovery within 6 months, possible additional recovery at up to 2 years.

여러 마디 경추 수술을 받을 환자는 반드시 경추 5 신경 마비에 대해서 정확한 설명을 들어야 하고 의료진도 반드시 경추 5 신경마비 가능성에 대해서 설명하고 그것의 회복에 대해서도 알려주어야 한다는 내용 입니다.


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