The association between preoperative spinal cord rotation and postoperative C5 nerve palsy
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.
UMass Chan Affiliations
Department of Orthopedics and Physical RehabilitationDocument Type
Journal ArticlePublication Date
2012-09-05Keywords
AdultAged
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
Metadata
Show full item recordAbstract
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.00664Permanent Link to this Item
http://hdl.handle.net/20.500.14038/42929PubMed ID
22992851Related Resources
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