Artikel
Shoulder depression should be avoided during anterior cervical surgery to reduce postoperative C5 nerve root palsy – a prospective multicentric cohort study with 1,244 patients
Intraoperative Depression der Schulter sollte bei ventralen zervikalen Eingriffen vermieden werden um postoperative C5-Paresen zu reduzieren – Eine prospektive Multicenter-Studie in 1,244 Patienten
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Autoren
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Sebastian Ille
- Klinikum rechts der Isar der TU München, Klinik und Poliklinik für Neurochirurgie, München, Deutschland
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Sandro M. Krieg
- Klinikum rechts der Isar der TU München, Klinik und Poliklinik für Neurochirurgie, München, Deutschland
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Frank W. Floeth
- Hospital zum Heiligen Geist, Kempen, Department of Spine Surgery, Kempen, Deutschland
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Arthur Wagner
- Klinikum rechts der Isar der TU München, Klinik und Poliklinik für Neurochirurgie, München, Deutschland
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Peter Vajkoczy
- Charité – Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland
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Claudius Thomé
- Medizinische Universität Innsbruck, Universitätsklinik für Neurochirurgie, Innsbruck, Österreich
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Sebastian Siller
- Klinikum der Ludwig-Maximilians-Universität München, Neurochirurgische Klinik und Poliklinik, München, Deutschland
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Stefanie Maurer
- Vivantes Klinikum Neukölln, Klinik für Neurochirurgie, Berlin, Deutschland
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Andreas Joedicke
- Vivantes Klinikum Neukölln, Klinik für Neurochirurgie, Berlin, Deutschland
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Elisabeth Török
- Helios Clinic Krefeld, Department of Neurosurgery, Krefeld, Deutschland
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Michael Stoffel
- Helios Clinic Krefeld, Department of Neurosurgery, Krefeld, Deutschland
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Sven Oliver Eicker
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurochirurgie, Hamburg, Deutschland
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Marcus Richter
- Spine Center St.-Josefs Hospital, Wiesbaden, Deutschland
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Bernhard Meyer
- Klinikum rechts der Isar der TU München, Klinik und Poliklinik für Neurochirurgie, München, Deutschland
| Veröffentlicht: | 25. Mai 2022 |
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Gliederung
Text
Objective: Anterior cervical discectomy and fusion (ACDF) and cervical vertebral body replacement of (VBR) are associated with a relatively low rate of complications. Yet, C5 nerve root palsy (C5P) is a severe one, ranging from 3 to 15% of patients referring to current literature. Its pathogenesis remains unclear despite various theories and studies. Our hypothesis was that intraoperative shoulder depression contributes significantly to this severe complication.
The aim of the present study was to prospectively examine the incidence and pathogenesis of postoperative C5P after anterior cervical surgery via a multicentric approach focusing on this very question. The participating centers were blinded to the main objective of the study in order not to bias their standard procedure.
Methods: From 2018 to 2021, 9 spine centers prospectively included 1,244 patients (58.5% men, mean±SD age 57±13 years) suffering from degenerative or traumatic diseases of the cervical spine undergoing ACDF of VBR. Standardized examination was performed preoperatively, one day postoperatively, day of discharge, and 2 months postoperatively.
Results: Overall, postoperative C5P occurred in 3.94% of cases. Of those, 20 were transient and 29 permanent. Patients with C5P were significantly older (p=0.002) while gender, body-mass-index, and secondary diagnoses could not be identified as predictors. Besides significant differences in radiological measures, patients with C5P underwent surgery with longer incision-to-suture times (p<0.0001) and more levels (p<0.0001). The duration of shoulder depression had a significant impact on C5P (p=0.002), without clear cut-off value in maximum tolerable time.
Conclusion: The occurrence of C5P after anterior cervical surgery is 3.94%. Our hypothesis that C5P is associated with prolonged intraoperative shoulder depression was confirmed and should be avoided in order to decrease the risk of C5P.
