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徐 晨, 周 铭, 陈 楚, 王 洪, 蒋 苏. [Cause analysis and clinical intervention of C 5 palsy after cervical surgery]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2024; 38:608-612. [PMID: 38752249 PMCID: PMC11096878 DOI: 10.7507/1002-1892.202402006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 04/18/2024] [Accepted: 04/18/2024] [Indexed: 05/18/2024]
Abstract
Objective To review the research progress of C 5 palsy (C 5P) after cervical surgery, providing new clinical intervention ideas for the C 5P patients. Methods The relevant literature domestically and abroad was extensively consulted and the latest developments in the incidence, risk factors, manifestations and diagnosis, prevention, and intervention measures of C 5P were systematically expounded. Results C 5P is characterized by weakness in the C 5 nerve innervation area after cervical decompression surgery, manifested as limited shoulder abduction and elbow flexion, with an incidence rate more than 5%, often caused by segmental spinal cord injury or mechanical injury to the nerve roots. For patients with risk factors, careful operation and preventive measures can reduce the incidence of C 5P. Most of the patients can recover with conservative treatment such as drug therapy and physical therapy, while those without significant improvement after 6 months of treatment may require surgical intervention such as foraminal decompression and nerve displacement. Conclusion Currently, there has been some advancement in the etiology and intervention of C 5P. Nevertheless, further research is imperative to assess the timing of intervention and surgical protocol.
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Affiliation(s)
- 晨霈 徐
- 复旦大学附属华山医院手外科(上海 200040)Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, 200040, P. R. China
- 国家卫生健康委员会手功能重建重点实验室(上海 200032)National Health Commission Key Laboratory of Hand Reconstruction, Shanghai, 200032, P. R. China
- 上海市周围神经显微外科重点实验室(上海 200032)Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, 200032, P. R. China
- 复旦大学附属华山医院国家老年疾病临床医学研究中心(上海 200040)National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, P. R. China
- 上海市手外科研究所(上海 200040)Institute of Hand Surgery, Shanghai, People’s Republic of China, Shanghai, 200040, P. R. China
- 复旦大学手外科研究所(上海 200040)Institute of Hand Surgery, Fudan University, Shanghai, 200040, P. R. China
| | - 铭杰 周
- 复旦大学附属华山医院手外科(上海 200040)Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, 200040, P. R. China
- 国家卫生健康委员会手功能重建重点实验室(上海 200032)National Health Commission Key Laboratory of Hand Reconstruction, Shanghai, 200032, P. R. China
- 上海市周围神经显微外科重点实验室(上海 200032)Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, 200032, P. R. China
- 复旦大学附属华山医院国家老年疾病临床医学研究中心(上海 200040)National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, P. R. China
- 上海市手外科研究所(上海 200040)Institute of Hand Surgery, Shanghai, People’s Republic of China, Shanghai, 200040, P. R. China
- 复旦大学手外科研究所(上海 200040)Institute of Hand Surgery, Fudan University, Shanghai, 200040, P. R. China
| | - 楚翔 陈
- 复旦大学附属华山医院手外科(上海 200040)Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, 200040, P. R. China
- 国家卫生健康委员会手功能重建重点实验室(上海 200032)National Health Commission Key Laboratory of Hand Reconstruction, Shanghai, 200032, P. R. China
- 上海市周围神经显微外科重点实验室(上海 200032)Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, 200032, P. R. China
- 复旦大学附属华山医院国家老年疾病临床医学研究中心(上海 200040)National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, P. R. China
- 上海市手外科研究所(上海 200040)Institute of Hand Surgery, Shanghai, People’s Republic of China, Shanghai, 200040, P. R. China
- 复旦大学手外科研究所(上海 200040)Institute of Hand Surgery, Fudan University, Shanghai, 200040, P. R. China
| | - 洪立 王
- 复旦大学附属华山医院手外科(上海 200040)Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, 200040, P. R. China
- 国家卫生健康委员会手功能重建重点实验室(上海 200032)National Health Commission Key Laboratory of Hand Reconstruction, Shanghai, 200032, P. R. China
| | - 苏 蒋
- 复旦大学附属华山医院手外科(上海 200040)Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, 200040, P. R. China
- 国家卫生健康委员会手功能重建重点实验室(上海 200032)National Health Commission Key Laboratory of Hand Reconstruction, Shanghai, 200032, P. R. China
- 上海市周围神经显微外科重点实验室(上海 200032)Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, 200032, P. R. China
- 复旦大学附属华山医院国家老年疾病临床医学研究中心(上海 200040)National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, P. R. China
- 上海市手外科研究所(上海 200040)Institute of Hand Surgery, Shanghai, People’s Republic of China, Shanghai, 200040, P. R. China
- 复旦大学手外科研究所(上海 200040)Institute of Hand Surgery, Fudan University, Shanghai, 200040, P. R. China
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Lubelski D, Pennington Z, Kopparapu S, Sciubba DM, Bishop AT, Shin AY, Spinner RJ, Belzberg AJ. Nerve Transfers After Cervical Spine Surgery: Multi-Institutional Case Series and Review of the Literature. World Neurosurg 2021; 156:e222-e228. [PMID: 34536618 DOI: 10.1016/j.wneu.2021.09.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/08/2021] [Accepted: 09/08/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Up to 10% of cervical spine surgeries are complicated by postoperative weakness. Although many patients recover with nonoperative management, some require surgery for restoration of function. OBJECTIVE To present the indications and outcomes of patients undergoing nerve transfers after developing weakness secondary to cervical spine decompression. METHODS A retrospective review of patients from 2 academic medical centers who underwent nerve transfer for C5-6 root injury after cervical spine surgery was performed. RESULTS Of the 10 treated patients, 9 experienced recovery at last follow-up, demonstrating improvements in strength and motion in the affected muscles. Successful nerve transfers occurred between 3 and 8 months after the index spinal surgery and included spinal accessory nerve to suprascapular nerve, triceps branch to anterior division of the axillary nerve, and/or ulnar or median fascicles to motor branches of the musculocutaneous nerve. The unsuccessful patient underwent nerve transfer surgery approximately 11 months after the index operation and failed to obtain functional recovery. CONCLUSIONS Patients who experience C5-6 weakness after cervical spine surgery should be evaluated and considered for nerve transfer surgery if they have continued severe functional deficits at 6 months postoperatively. Earlier referral for nerve transfer is associated with improved functional outcomes in this cohort.
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Affiliation(s)
- Daniel Lubelski
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Zach Pennington
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Srujan Kopparapu
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Allen T Bishop
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Alexander Y Shin
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Robert J Spinner
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Allan J Belzberg
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, USA.
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Preoperative electrophysiologic assessment of C5-innervated muscles in predicting C5 palsy after posterior cervical decompression. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:1681-1688. [PMID: 33555367 DOI: 10.1007/s00586-021-06757-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/28/2020] [Accepted: 01/26/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To investigate the feasibility of both needle electromyography (EMG) and proximal nerve conduction studies (NCS) in predicting C5 palsy after posterior cervical decompression. METHODS This study included 192 patients with cervical myelopathy undergoing laminoplasty or laminectomy. Preoperatively, all patients accepted bilateral needle EMG detection and proximal NCS that consisted of supramaximally stimulating Erb's point and recording compound muscle action potential (CMAP) from bilateral deltoid. RESULTS In the present study, 11 (11/192, 5.7%) patients developed unilateral C5 palsy after operation, and more patients with C5 palsy showed abnormal spontaneous activity in C5-innervated muscles compared to those without C5 palsy (8/11 vs. 16/181, p < 0.05). The sensitivity and specificity of spontaneous activity in C5-innervated muscles in predicting postoperative C5 palsy were 72.7% and 91.2%, respectively. Furthermore, there were significant left-to-right differences of deltoid CMAP amplitudes between the patients with and without C5 palsy (p < 0.05), and this measurement was also demonstrated to be useful for distinguishing patients with C5 palsy from cases without C5 palsy by receiver operating characteristic (ROC) curve analysis (cut-off value: 2.1 mV, sensitivity: 63.6%; specificity: 95.0%). In addition, the sensitivity and specificity of a series application of these two measurements were 63.6% and 100.0%, respectively. CONCLUSIONS The findings of this study support the hypothesis that pre-existing progressive C5 root injury may be a risk factor for C5 palsy after posterior cervical decompression. Clinically, the estimation of NCS and needle EMG in C5-innervated muscles may provide additional useful information for predicting C5 palsy after cervical spinal surgery. LEVEL OF EVIDENCE I Diagnostic: individual cross-sectional studies with the consistently applied reference standard and blinding.
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