title: The use of cooled saline during bone drilling to reduce the incidence of upper-limb palsy after cervical laminoplasty: clinical article.
abstract: OBJECTIVE
  No previous hypothesis has attempted to fully account for the occurrence of upper-limb palsy (ULP) after cervical laminoplasty. The authors propose that friction-generated heat from a high-speed drill may cause thermal injury to the nerve roots close to the drilled bone, which may then lead to ULP. The authors investigated the effect of cooling the saline used for irrigation during the drilling on the incidence of upper-limb (C-5) palsy following cervical laminoplasty.
  
  
  METHODS
  The irrigation saline for drilling was used at room temperature (RT, average temperature of 25.6°C) in operations of 79 patients (the RT group) and cooled to an average of 12.1°C in operations of 80 patients (the low-temperature [LT] group). The authors used a hand-held dynamometer to precisely assess muscle strength presurgery and 2 weeks postsurgery.
  
  
  RESULTS
  There was a 7.6% and 1.9% decrease in the strength of the deltoid muscle, a 10.1% and 4.4% decrease in the strength of the biceps brachii, a 1.3% and 0.6% decrease in the strength of the triceps brachii, and a 7.6% and 3.1% decrease in grip strength in the RT and LT groups, respectively. Multivariate analysis revealed that a significant predictor for decreased deltoid muscle strength was the use of irrigation saline at RT.
  
  
  CONCLUSIONS
  Using cooled irrigation saline during bone drilling significantly decreased the incidence of ULP and can thus be recommended as a simple method for the prevention of ULP.
authors: Department of Orthopaedic Surgery, Osaka Kosei-nenkin Hospital, Fukushima, Osaka, Japan.
authors: Shota
authors: S
authors: Takenaka
authors: Noboru
authors: N
authors: Hosono
authors: Yoshihiro
authors: Y
authors: Mukai
authors: Toshitada
authors: T
authors: Miwa
authors: Takeshi
authors: T
authors: Fuji
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000601:surgery*; D003080:Cold Temperature; D005260:Female; D006801:Humans; D007796:Laminectomy / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D010243:Paralysis / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D012965:Sodium Chloride; D013122:Spinal Diseases / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D012965:Sodium Chloride