Back to Search Start Over

Postoperative Delayed Cervical Palsies: Understanding the Etiology.

Authors :
Planchard RF
Maloney PR
Mallory GW
Puffer RC
Spinner RJ
Nassr A
Fogelson JL
Krauss WE
Clarke MJ
Source :
Global spine journal [Global Spine J] 2016 Sep; Vol. 6 (6), pp. 571-83. Date of Electronic Publication: 2016 Jan 05.
Publication Year :
2016

Abstract

Study Design: Retrospective study.<br />Objective: This study reviews 1,768 consecutive cervical decompressions with or without instrumented fusion to identify patient-specific and procedural risk factors significantly correlated with the development of delayed cervical palsy (DCP).<br />Methods: Baseline demographic and procedural information was collected from the electronic medical record. Particular attention was devoted to reviewing each chart for recognized risk factors of postsurgical inflammatory neuropathy: autoimmune disease, blood transfusions, diabetes, and smoking.<br />Results: Of 1,669 patients, 56 (3.4%) developed a DCP. Although 71% of the palsies involved C5, 55% of palsies were multimyotomal and 18% were bilateral. Significant risk factors on univariate analysis included age (p = 0.0061, odds ratio [OR] = 1.07, 95% confidence interval [CI] 1.008 to 1.050), posterior instrumented fusion (p < 0.0001, OR = 3.30, 95% CI 1.920 to 5.653), prone versus semisitting/sitting position (p = 0.0036, OR = 3.58, 95% CI 1.451 to 11.881), number of operative levels (p < 0.0001, OR = 1.42, 95% CI 1.247 to 1.605), intraoperative transfusions (p = 0.0231, OR = 2.57, 95% CI 1.152 to 5.132), and nonspecific autoimmune disease (p = 0.0107, OR = 3.83, 95% CI 1.418 to 8.730). On multivariate analysis, number of operative levels (p = 0.0053, OR = 1.27, 95% CI 1.075 to 1.496) and nonspecific autoimmune disease (p = 0.0416, OR 2.95, 95% CI 1.047 to 7.092) remained significant.<br />Conclusions: Although this study partially supports a mechanical etiology in the pathogenesis of a DCP, we also describe a notable correlation with autoimmune risk factors. Bilateral and multimyotomal involvement provides additional support that some DCPs may result from an inflammatory response and thus an underlying multifactorial etiology for this complication.

Details

Language :
English
ISSN :
2192-5682
Volume :
6
Issue :
6
Database :
MEDLINE
Journal :
Global spine journal
Publication Type :
Academic Journal
Accession number :
27555999
Full Text :
https://doi.org/10.1055/s-0035-1570084