title: Preoperative Risk Factors of C5 Nerve Root Palsy After Laminectomy and Fusion in Patients With Cervical Myelopathy: Analysis of 70 Consecutive Patients.
abstract: METHODS
  A retrospective study.
  
  
  OBJECTIVE
  To identify preoperative risk factors causing cervical fifth nerve root palsy (C5 palsy) after laminectomy and fusion (LF).
  
  
  BACKGROUND
  It is well known that postoperative C5 palsy is not rare after cervical surgery. Although there remains controversy, C5 palsy is considered to be more common in patients who had LF than in those who had laminoplasty. However, the reason for the higher incidence of C5 palsy in patients with LF has been poorly understood.
  
  
  METHODS
  A total of 70 consecutive patients (mean age: 60.3 y) who had LF due to cervical myelopathy were reviewed. Patients were divided on the basis of the presence (group P) or absence (group N) of C5 palsy. Among various risk factors for C5 palsy from previous reports, 6 risk factors were selected as follows: (1) preoperative low Japanese Orthopedic Association score, (2) postoperatively increased lordosis, (3) low Pavlov ratio, (4) high signal intensity in the cord at C3-C5, (5) anterior protruding mass lesion compressing the spinal cord, and (6) presence of C4-C5 foraminal stenosis. With these factors, the 2 groups were compared by statistical analysis.
  
  
  RESULTS
  C5 palsy occurred in 10 patients (14.3%). The mean onset time was 3.5 days (range, 1-8 d) and the mean recovery time was 3.4 months (range, 1-7 mo). There were no significant differences in the preoperative Japanese Orthopedic Association score, cervical lordosis, Pavlov ratio, high signal intensity, and anterior protruding mass between the 2 groups (P>0.05). However, C4-C5 foraminal stenosis was found in 80.0% (8/10) in group P and 21.7% (13/60) in group N. There were significant differences between the 2 groups in C4-C5 foraminal stenosis (P=0.004).
  
  
  CONCLUSIONS
  In this study, a high occurrence rate and risk factor for C5 palsy were verified after LF. Among the various factors, C4-C5 foraminal stenosis was the only risk factor for C5 palsy. Preoperative warning for C5 palsy after LF seems to be imperatively necessary, especially in patients with C4-C5 foraminal stenosis.
authors.affiliation: *Department of Orthopaedic Surgery, Kyung Hee University Hospital, Kyung Hee University †Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Kyung-Chung
authors.initials: KC
authors.lastname: Kang
authors.forename: Kyung-Soo
authors.initials: KS
authors.lastname: Suk
authors.forename: Hak-Sun
authors.initials: HS
authors.lastname: Kim
authors.forename: Seong-Hwan
authors.initials: SH
authors.lastname: Moon
authors.forename: Hwan-Mo
authors.initials: HM
authors.lastname: Lee
authors.forename: Jung-Ho
authors.initials: JH
authors.lastname: Seo
authors.forename: Sung-Min
authors.initials: SM
authors.lastname: Kim
authors.forename: Sung-Yub
authors.initials: SY
authors.lastname: Jin
authors.forename: Pierre
authors.initials: P
authors.lastname: Mella
mesh_terms: D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D007796:Laminectomy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010243:Paralysis / Q000000981:diagnostic imaging / Q000209:etiology*; D011300:Preoperative Care; D012307:Risk Factors; D013123:Spinal Fusion / Q000009:adverse effects*; D013126:Spinal Nerve Roots / Q000000981:diagnostic imaging / Q000601:surgery*