Asian Spine J.  2016 Apr;10(2):298-308. 10.4184/asj.2016.10.2.298.

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

  • 1Department of Orthopaedic Surgery, Karatsu Red Cross Hospital, Karatsu, Japan.


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.
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.
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.
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.


C5 palsy; Double door laminoplasty; Cervical spondylotic myelopathy
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