title: Significant reduction in the incidence of C5 palsy after cervical laminoplasty using chilled irrigation water.
abstract: OBJECTIVE
  The aim of this study was to determine whether chilled irrigation saline decreases the incidence of clinical upper limb palsy (ULP; a reduction of one grade or more on manual muscle testing; MMT), based on the idea that ULP results from thermal damage to the nerve roots by heat generated by friction during bone drilling.
  
  
  METHODS
  Irrigation saline for drilling was used at room temperature (RT, 25.6°C) in open-door laminoplasty in 400 patients (RT group) and chilled to a mean temperature of 12.1°C during operations for 400 patients (low-temperature (LT) group). We assessed deltoid, biceps, and triceps brachii muscle strength by MMT. ULP occurring within two days post-operatively was categorised as early-onset palsy.
  
  
  RESULTS
  The incidence of ULP (4.0% vs 9.5%, p = 0.003), especially early-onset palsy (1.0% vs 5.5%, p < 0.001), was significantly lower for the LT group than for the RT group. Multivariate analysis indicated that RT irrigation saline use, concomitant foraminotomy, and opened side were significant predictors for ULP.
  
  
  CONCLUSIONS
  Using chilled irrigation saline during bone drilling significantly decreased the ULP incidence, particularly the early-onset type, and shortened the recovery period for ULP. Chilled irrigation saline can thus be recommended as a simple method for preventing ULP.
  
  
  CONCLUSIONS
  Chilled irrigation during laminoplasty reduces C5 palsy.
authors.affiliation: Japan Community Healthcare Organization Osaka Hospital, Fukushima 4-2-78, Osaka 553-0003, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Takenaka
authors.affiliation: Japan Community Healthcare Organization Osaka Hospital, Fukushima 4-2-78, Osaka 553-0003, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Hosono
authors.affiliation: Japan Community Healthcare Organization Osaka Hospital, Fukushima 4-2-78, Osaka 553-0003, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Mukai
authors.affiliation: Japan Community Healthcare Organization Osaka Hospital, Fukushima 4-2-78, Osaka 553-0003, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Tateishi
authors.affiliation: Japan Community Healthcare Organization Osaka Hospital, Fukushima 4-2-78, Osaka 553-0003, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Fuji
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001132:Arm / Q000294:innervation; D016063:Blood Loss, Surgical; D002574:Cervical Vertebrae / Q000601:surgery*; D017679:Cryotherapy / Q000379:methods*; D005260:Female; D006801:Humans; D065406:Laminoplasty / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology; D018482:Muscle, Skeletal / Q000502:physiology; D061646:Operative Time; D010243:Paralysis / Q000517:prevention & control*; D011183:Postoperative Complications / Q000517:prevention & control; D011446:Prospective Studies; D012965:Sodium Chloride / Q000008:administration & dosage; D007507:Therapeutic Irrigation / Q000379:methods*
chemical_list: D012965:Sodium Chloride
keywords: C-5 palsy; IPTW; cervical myelopathy; cervical spondylotic myelopathy; inverse probability of treatment weighting; laminoplasty; surgical procedure; upper-limb palsy