1. The anatomical mechanism of C5 palsy after expansive open-door laminoplasty
- Author
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Rusen Zhang, Weijia Zhu, Zezheng Liu, Qingchu Li, Runxun Ma, Qinghao Zhao, Jianjun Zhao, Hui-bo Yan, Liang Cheng, and Shanxi Deng
- Subjects
Male ,Nerve root ,medicine.medical_treatment ,Spinal Cord Diseases ,Laminoplasty ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Cadaver ,medicine ,Humans ,Paralysis ,Orthopedics and Sports Medicine ,Spinal canal ,Intervertebral foramen ,Aged ,030222 orthopedics ,business.industry ,Anatomy ,Middle Aged ,Spinal cord ,Vertebra ,medicine.anatomical_structure ,Spinal nerve ,Cervical Vertebrae ,Female ,Surgery ,Neurology (clinical) ,Spinal Nerve Roots ,business ,030217 neurology & neurosurgery - Abstract
Background Postoperative C5 palsy is not an uncommon complication in patients who undergo expansive open-door laminoplasty. However, the etiology is unclear and likely multifactorial. Nerve root lesions and spinal cord lesions have been previously proposed theories. Purpose To investigate the anatomical mechanism of postoperative C5 palsy after cervical expansive open-door laminoplasty. Study design A dissection-based study of 8 embalmed human cadavers. Methods The anatomy was studied in 8 whole cervical cadavers (3 females, 5males), prepared with formaldehyde, whose ages at the time of death ranged from 54 to 78 years. Dissection was performed on the intervertebral foramen and spinal canal. In the C3-C7 of the cervical vertebra, the extraforaminal ligaments and the meningovertebral ligaments were observed. The length, width, and thickness of the ligaments were measured with a vernier caliper. After an expansive open-door laminoplasty was performed, the shape of the dural sac was changed, and displacement of the nerve root was observed. In addition, the lengths of the anterior rootlets were measured. This study has been supported by grants from Science and Technology Planning Project of Guangdong Province (CN) (Grant No. 2017B020210010) without potential conflict of interest-associated biases in the text of the paper. Results One hundred seventy-seven extraforaminal ligaments were found to connect the spinal nerve to the surrounding structures. After an expansive open-door laminoplasty was performed, posterior distension of the dural sac, and movement of the spinal cord and nerve root were found. The spinal cord was closely attached to the ligamentum flavum by meningovertebral ligaments. In addition, the length of the C5 intradural rootlets (5.81-10.59 mm) was the shortest among the vulnerable segments. Conclusion Traction on and posterior movement of the extradural roots may be the main pathological mechanism of postoperative C5 palsy when expansive open-door laminoplasty is performed. The meningovertebral ligaments and EFLs might play an important role in the occurrence of postoperative C5 palsy. Clinical Significance This study provides clinicians with a more detailed understanding of the anatomic structure and potential mechanism of C5 palsy. Consideration of the meningovertebral ligaments and the intervertebral foramen may provide new directions for reducing the incidence of this complication.
- Published
- 2020
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