Mahmoud AbdouFayoum University, Egypt
Title: Posterior expansive foraminotomy combined with pedicle screw fixation can decrease the incidence of C5 palsy in complex cervical spine surgery in patients with severe myeloradiculopathy
Study Design: A retrospective cohort study.
Objective: To investigate different techniques for foramen decompression with posterior cervical fusion and assess the incidence of C5 palsy with each technique.
Summary of Background Data: In concert with the increasing age of the population, the frequencies of cervical myelopathy and myeloradiculopathy have also increased. C5 palsy is a frequent sequela of cervical decompression surgeries. Although many researchers have suggested that foramen size is an independent risk factor for C5 palsy, there is no consensus regarding this issue.
Methods: A total of 362 patients were investigated: 208 underwent posterior decompression with lateral mass screws, followed by an anterior approach with uncovertebrectomy and finally posterior rod insertion (PAP LMS group); 72 underwent a posterior approach with pedicle screw insertion and foraminotomy, followed by anterior decompression and finally posterior rod insertion (PAP pedicle group); and 82 underwent posterior laminectomy and foraminotomy with pedicle screws (posterior pedicle group). Motor manual testing was performed preoperatively and postoperatively to assess C5 palsy. Neck Disability Index (NDI) and Japanese Orthopedic Association (JOA) scores were determined before and after surgery to evaluate myelopathy symptoms and neck pain. Lateral radiographs were obtained to assess cervical lordosis (C2–C7 Cobb angle, C2–C7 sagittal vertical axis [SVA], C2 slope, T1 slope, and T1s–CL [T1 slope minus C2–C7 Cobb angle]) preoperatively and postoperatively.
Results: The incidence of C5 palsy was significantly lower in posterior foraminotomy groups with pedicle screws (groups 2 and 3) than in LMS with uncovertebrectomy (group 1) (p<0.001). Postoperative cervical lordosis parameters (T1s–CL, and C2–C7 Cobb angle) were significantly better in the PAP pedicle group than in the other two groups (p<0.001).
Conclusion: Preventive expansive foraminotomy can significantly decrease the incidence of C5 palsy associated with posterior and combined posterior and anterior cervical fusion surgeries. Expansive foraminotomy is only appropriate with pedicle screw insertion to preserve stability.