Skip to main content

Advertisement

Log in

Preoperative electrophysiologic assessment of C5-innervated muscles in predicting C5 palsy after posterior cervical decompression

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

To investigate the feasibility of both needle electromyography (EMG) and proximal nerve conduction studies (NCS) in predicting C5 palsy after posterior cervical decompression.

Methods

This study included 192 patients with cervical myelopathy undergoing laminoplasty or laminectomy. Preoperatively, all patients accepted bilateral needle EMG detection and proximal NCS that consisted of supramaximally stimulating Erb’s point and recording compound muscle action potential (CMAP) from bilateral deltoid.

Results

In the present study, 11 (11/192, 5.7%) patients developed unilateral C5 palsy after operation, and more patients with C5 palsy showed abnormal spontaneous activity in C5-innervated muscles compared to those without C5 palsy (8/11 vs. 16/181, p < 0.05). The sensitivity and specificity of spontaneous activity in C5-innervated muscles in predicting postoperative C5 palsy were 72.7% and 91.2%, respectively. Furthermore, there were significant left-to-right differences of deltoid CMAP amplitudes between the patients with and without C5 palsy (p < 0.05), and this measurement was also demonstrated to be useful for distinguishing patients with C5 palsy from cases without C5 palsy by receiver operating characteristic (ROC) curve analysis (cut-off value: 2.1 mV, sensitivity: 63.6%; specificity: 95.0%). In addition, the sensitivity and specificity of a series application of these two measurements were 63.6% and 100.0%, respectively.

Conclusions

The findings of this study support the hypothesis that pre-existing progressive C5 root injury may be a risk factor for C5 palsy after posterior cervical decompression. Clinically, the estimation of NCS and needle EMG in C5-innervated muscles may provide additional useful information for predicting C5 palsy after cervical spinal surgery.

Level of evidence I

Diagnostic: individual cross-sectional studies with the consistently applied reference standard and blinding.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Code availability

Not applicable.

References

  1. Nori S, Aoyama R, Ninomiya K et al (2017) Cervical laminectomy of limited width prevents postoperative C5 palsy: a multivariate analysis of 263 muscle-preserving posterior decompression cases. Eur Spine J 26:2393–2403

    Article  Google Scholar 

  2. Sakaura H, Hosono N, Mukai Y et al (2003) C5 palsy after decompression surgery for cervical myelopathy: review of the literature. Spine 28:2447–2451

    Article  Google Scholar 

  3. Shou F, Li Z, Wang H et al (2015) Prevalence of C5 nerve root palsy after cervical decompressive surgery: a meta-analysis. Eur Spine J 24:2724–2734

    Article  Google Scholar 

  4. Wang T, Wang H, Liu S et al (2017) Incidence of C5 nerve root palsy after cervical surgery: a meta-analysis for last decade. Medicine (Baltimore) 96:e8560

    Article  Google Scholar 

  5. Guzman JZ, Baird EO, Fields AC et al (2014) C5 nerve root palsy following decompression of the cervical spine: a systematic evaluation of the literature. Bone Joint J 96B:950–955

    Article  Google Scholar 

  6. Miller JA, Lubelski D, Alvin MD et al (2014) C5 palsy after posterior cervical decompression and fusion: cost and quality-of-life implications. Spine J 14:2854–2860

    Article  Google Scholar 

  7. Sasai K, Saito T, Akagi S et al (2003) Preventing C5 palsy after laminoplasty. Spine 28:1972–1977

    Article  Google Scholar 

  8. Lee HJ, Ahn JS, Shin B et al (2017) C4/5 foraminal stenosis predicts C5 palsy after expansive open-door laminoplasty. Eur Spine J 26:2340–2347

    Article  Google Scholar 

  9. Takeuchi M, Wakao N, Kamiya M et al (2018) Simple presurgical method of predicting C5 palsy after cervical laminoplasty using C5 nerve root ultrasonography. J Neurosurg Spine 29:365–370

    Article  Google Scholar 

  10. Choi BW, Kim SS, Lee DH et al (2017) Cervical radiculopathy combined with cervical myelopathy: prevalence and characteristics. Eur J Orthop Surg Traumatol 27:889–893

    Article  Google Scholar 

  11. Kimura J (2001) Electrodiagnosis in diseases of nerve and muscle: principles and practice, 3rd edn. Oxford University Press, New York

    Google Scholar 

  12. Tani T, Kishimoto H, Tsuboya H et al (2002) Electrophysiologic assessment of shoulder girdle weakness in patients with cervical spondylosis: prognostic value of supraclavicular stimulation. J Clin Neuromuscul Dis 4:11–18

    Article  Google Scholar 

  13. Nafissi S, Niknam S, Hosseini SS (2012) Electrophysiological evaluation in lumbosacral radiculopathy. Iran J Neurol 11:83–86

    PubMed  PubMed Central  Google Scholar 

  14. Preston DC, Ellen B (2002) Electromyography and neuromuscular disorders. Elsevier Butterworth-Heinemann, Philadelphia

    Google Scholar 

  15. Chen L, Yang H, Yang T et al (2009) Effectiveness of surgical treatment for traumatic central cord syndrome. J Neurosurg Spine 10:3–8

    Article  Google Scholar 

  16. Lenehan B, Fisher CG, Vaccaro A et al (2010) The urgency of surgical decompression in acute central cord injuries with spondylosis and without instability. Spine (Phila Pa 1976) 35:180–186

    Article  Google Scholar 

  17. Burke D, Kiernan MC, Bostock H (2001) Excitability of human axons. Clin Neurophysiol 112:1575–1585

    Article  CAS  Google Scholar 

  18. Zheng C, Zhu Y, Nie C et al (2018) Altered motor axonal excitability in patients with cervical spondylotic amyotrophy. Clin Neurophysiol 129:1383–1389

    Article  Google Scholar 

  19. Hasegawa K, Homma T, Chiba Y (2007) Upper extremity palsy following cervical decompression surgery results from a transient spinal cord lesion. Spine 32:E197–E202

    Article  Google Scholar 

  20. Lin CS, Macefield VG, Elam M et al (2007) Axonal changes in spinal cord injured patients distal to the site of injury. Brain 130:985–994

    Article  Google Scholar 

  21. Van De Meent H, Hosman AJ, Hendriks J et al (2010) Severe degeneration of peripheral motor axons after spinal cord injury: a European multicenter study in 345 patients. Neurorehabil Neural Repair 24:657–665

    Article  Google Scholar 

  22. Zheng C, Yu Q, Shan X et al (2020) Early surgical decompression ameliorates dysfunction of spinal motor neuron in patients with acute traumatic central cord syndrome: an ambispective cohort analysis. Spine 45:E829–E838

    Article  Google Scholar 

  23. Kim GU, Lee GW (2019) Selective blocking laminoplasty in cervical laminectomy and fusion to prevent postoperative C5 palsy. Spine J 19:617–623

    Article  Google Scholar 

  24. Bydon M, Macki M, Kaloostian P et al (2014) Incidence and prognostic factors of c5 palsy: a clinical study of 1001 cases and review of the literature. Neurosurgery 74:595–604

    Article  Google Scholar 

  25. Oshina M, Segawa T, Oshima Y et al (2020) C5 palsy after C5/6/7 posterior foraminal decompression: A case report. Medicine (Baltimore) 99:e18817

    Article  Google Scholar 

Download references

Funding

Financial support from the National Natural Science Foundation of China Youth Science Foundation Project (81802145; 81871552) is gratefully acknowledged.

Author information

Authors and Affiliations

Authors

Contributions

XX and LFZ have made substantial contributions to conception and design; ZC, NC and XM have made substantial contributions to acquisition of data, or analysis and interpretation of data; ZY and JJ have been involved in drafting the manuscript or revising it critically for important intellectual content; all authors have given final approval of the version to be published.

Corresponding author

Correspondence to Xinlei Xia.

Ethics declarations

Conflict of interest

None of the authors has potential conflicts of interest to be disclosed. The authors alone are responsible for the content and writing of this paper.

Availability of data and material

The datasets have been presented in the main manuscript, and the raw data used and/or analysed during the current study are available from the corresponding author on reasonable request.

Ethics approval

This study protocol was approved by the Ethics Committee of Huashan Hospital (Fudan University, Shanghai, China), and informed consent was obtained from all participants.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zheng, C., Nie, C., Zhu, Y. et al. Preoperative electrophysiologic assessment of C5-innervated muscles in predicting C5 palsy after posterior cervical decompression. Eur Spine J 30, 1681–1688 (2021). https://doi.org/10.1007/s00586-021-06757-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-021-06757-9

Keywords

Navigation