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    The association between preoperative spinal cord rotation and postoperative C5 nerve palsy

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    Authors
    Eskander, Mark S.
    Balsis, Steve
    Balinger, Chris
    Howard, Caitlin M.
    Lewing, Nicholas W.
    Eskander, Jonathan P.
    Aubin, Michelle E.
    Lange, Jeffrey
    Eck, Jason C.
    Connolly, Patrick J.
    Jenis, Louis G.
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    UMass Chan Affiliations
    Department of Orthopedics and Physical Rehabilitation
    Document Type
    Journal Article
    Publication Date
    2012-09-05
    Keywords
    Adult
    Aged
    Brachial Plexus Neuropathies
    Cervical Vertebrae
    Cohort Studies
    Decompression, Surgical
    Female
    Humans
    Magnetic Resonance Imaging
    Male
    Middle Aged
    Paralysis
    Postoperative Complications
    Predictive Value of Tests
    Preoperative Care
    Registries
    Retrospective Studies
    Risk Assessment
    Rotation
    Sensitivity and Specificity
    Severity of Illness Index
    Spinal Cord
    Spinal Nerve Roots
    Spinal Stenosis
    Treatment Outcome
    Young Adult
    Orthopedics
    Rehabilitation and Therapy
    Surgery
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    Abstract
    BACKGROUND: C5 nerve palsy is a known complication of cervical spine surgery. The development and etiology of this complication are not completely understood. The purpose of the present study was to determine whether rotation of the cervical spinal cord predicts the development of a C5 palsy. METHODS: We performed a retrospective review of prospectively collected spine registry data as well as magnetic resonance images. We reviewed the records for 176 patients with degenerative disorders of the cervical spine who underwent anterior cervical decompression or corpectomy within the C4 to C6 levels. Our measurements included area for the spinal cord, space available for the cord, and rotation of the cord with respect to the vertebral body. RESULTS: There was a 6.8% prevalence of postoperative C5 nerve palsy as defined by deltoid motor strength of /= 11 degrees ) and palsy (point-biserial correlation = 0.94; p < 0.001). A diagnostic criterion of 6 degrees of rotation could identify patients who had a C5 palsy (sensitivity = 1.00 [95% confidence interval, 0.70 to 1.00], specificity = 0.97 [95% confidence interval, 0.93 to 0.99], positive predictive value = 0.71 [95% confidence interval, 0.44 to 0.89], negative predictive value = 1.00 [95% confidence interval, 0.97 to 1.00]). CONCLUSIONS: Our evidence suggests that spinal cord rotation is a strong and significant predictor of C5 palsy postoperatively. Patients can be classified into three types, with Type 1 representing mild rotation (0 degrees to 5 degrees ), Type 2 representing moderate rotation (6 degrees to 10 degrees ), and Type 3 representing severe rotation (>/= 11 degrees ). The rate of C5 palsy was zero of 159 in the Type-1 group, eight of thirteen in the Type-2 group, and four of four in the Type-3 group. This information may be valuable for surgeons and patients considering anterior surgery in the C4 to C6 levels.
    Source

    J Bone Joint Surg Am, 2012 Sep 05;94(17):1605-1609. doi: 10.2106/JBJS.K.00664. Link to article on publisher's site

    DOI
    10.2106/JBJS.K.00664
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/42929
    PubMed ID
    22992851
    Related Resources

    Link to Article in PubMed

    Rights
    Copyright © 2013. The Journal of Bone and Joint Surgery, Inc. Publisher PDF posted as allowed by the publisher's author rights policy at http://jbjs.org/public/reprintspermissions.aspx.
    ae974a485f413a2113503eed53cd6c53
    10.2106/JBJS.K.00664
    Scopus Count
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    UMass Chan Faculty and Researcher Publications
    Orthopedics and Physical Rehabilitation Publications

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