頸椎減壓術后頸5神經根麻痹影響因素研究進展_West China Medical Journal

Authors：

 王林楠 ,  宋躍明

四川大學華西醫院骨科（成都 610041）;

Corresponding?author：

宋躍明, Email: symcd@163.com

Keywords：

經頸椎減壓術; 術后頸5神經根麻痹; 發生機制; 預防措施; 預后

DOI：

10.7507/1002-0179.20150223

Video：

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頸椎減壓術后頸5神經根麻痹是頸椎減壓術后顯著的并發癥，也是影響患者對手術滿意度的頑疾之一。近年來，針對術后頸5神經根麻痹的發病機制及其影響因素有很多研究，提出了4種可能的發病機制假說：術中神經根損傷，脊髓節段性病理改變，減壓術后脊髓移位合并椎間孔狹窄所導致神經根栓系現象，脊髓缺血再灌注損傷。但目前尚無一種假說能夠完全合理解釋術后頸5神經根麻痹的發生。基于以上假說，關于術中脊髓監測和預防性頸5神經根椎間孔減壓是否能預防術后頸5神經根麻痹的研究也倍受關注。現回顧近年來相關的文獻，從發生率、發生機制、預防、治療及預后等方面的研究進展進行綜述。

Citation： 王林楠, 宋躍明. 頸椎減壓術后頸5神經根麻痹影響因素研究進展. West China Medical Journal, 2015, 30(4): 783-785. doi: 10.7507/1002-0179.20150223 Copy

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4.	Hasegawa K, Homma T, Chiba Y. Upper extremity palsy following cervical decompression surgery results from a transient spinal cord lesion[J]. Spine (Phila Pa 1976), 2007, 32(6):197-202.
5.	Shiozaki T, Otsuka H, Nakata YA, et al. Spinal cord shift on magnetic resonance imaging at 24 hours after cervical laminoplasty[J]. Spine (Phila Pa 1976), 2009, 34(3):274-279.
6.	Radcliff KE, Limthongkul W, Kepler CK, et al. Cervical laminectomy width and spinal cord drift are risk factors for postoperative C5 palsy[J]. J Spinal Disord Tech, 2014, 27(2):86-92.
7.	Imagama S, Matsuyama Y, Yukawa Y, et al. C5 palsy after cervical laminoplasty:a multicenter study[J]. J Bone Joint Surg Br, 2010, 92 (3):393-400.
8.	Katsumi K, Yamazaki A, Watanabe K, et al. Can prophylactic bilateral C4/C5 foraminotomy prevent postoperative C5 palsy after open-door laminoplasty? A prospective study[J]. Spine (Phila Pa 1976), 2012, 37(9):748-754.
9.	Hojo Y, Ito M, Abumi K, et al. A late neurological complication following posterior correction surgery of severe cervical kyphosis[J]. Eur Spine J, 2011, 20(6):890-898.
10.	Hashimoto M, Mochizuki M, Aiba A, et al. C5 palsy following anterior decompression and spinal fusion for cervical degenerative diseases[J]. Eur Spine J, 2010, 19(10):1702-1710.
11.	Odate S, Shikata J, Yamamura S, et al. Extremely wide and asymmetric anterior decompression causes postoperative C5 palsy[J]. Spine (Phila Pa 1976), 2013, 38(25):2184-2189.
12.	Chiba K, Toyama Y, Matsumoto M, et al. Segmental motor paralysis after expansive open-door laminoplasty[J]. Spine (Phila Pa 1976), 2002, 27(19):2108-2115.
13.	Seichi A, Takeshita K, Kawaguchi H, et al. Postoperative expansion of intramedullary high-intensity areas on T2-weighted magnetic resonance imaging after cervical laminoplasty[J]. Spine (Phila Pa 1976), 2004, 29(13):1478-1482.
14.	Fan DP, Schwartz DM, Vaccaro AR, et al. Intraoperative neurophysiologic detection of iatrogenic C5 nerve root injury during laminectomy for cervical compression myelopathy[J]. Spine (Phila Pa 1976), 2002, 27(22):2499-2502.
15.	Komagata M, Nishiyama M, Endo K, et al. Prophylaxis of C5 palsy after cervical expansive laminoplasty by bilateral partial foraminotomy[J]. Spine J, 2004, 3(22):650-655.
16.	趙棟, 鄧樹才, 馬毅. 頸椎減壓術后C5神經根麻痹[J]. 中國骨與關節外科, 2011, 4(4):317-321.
17.	Hosono N, Miwa T, Mukai Y, et al. Potential risk of thermal damage to cervical nerve Roots by a high-speed drill[J]. J Bone Joint Surg Br, 2009, 91 (11):1541-1544.
18.	余可誼, 邱貴興. 頸椎術后C_5神經根麻痹[J]. 脊柱外科雜志, 2004, 2(5):307-309.
19.	Currier BL. Neurological complications of cervical spine surgery C5 palsy and intraoperative monitoring[J]. Spine (Phila Pa 1976), 2012, 37(5):E328-E334.
20.	Sakaura H, Hosono N, Mukai Y, et al. C5 palsy after decompression surgery for cervical myelopathy[J]. Spine (Phila Pa 1976), 2003, 28(21):2447-2451.

1. Scoville WB. Cervical spondylosis treated by bilateral facetectomy and laminectomy[J]. J Neurosurg, 1961, 18(4):423-428.
2. Stoops WL, King RB. Neural complication of cervical spondylosis:their response to laminectomy and foraminotomy[J]. J Neurosurg, 1961, 19(11):986-999.
3. Nassr A, Jason C, William F, et al. The incidence of C5 palsy after multilevel cervical decompression procedures:a review of 750 consecutive cases[J]. Spine (Phila Pa 1976), 2012, 37(3):174-178.
4. Hasegawa K, Homma T, Chiba Y. Upper extremity palsy following cervical decompression surgery results from a transient spinal cord lesion[J]. Spine (Phila Pa 1976), 2007, 32(6):197-202.
5. Shiozaki T, Otsuka H, Nakata YA, et al. Spinal cord shift on magnetic resonance imaging at 24 hours after cervical laminoplasty[J]. Spine (Phila Pa 1976), 2009, 34(3):274-279.
6. Radcliff KE, Limthongkul W, Kepler CK, et al. Cervical laminectomy width and spinal cord drift are risk factors for postoperative C5 palsy[J]. J Spinal Disord Tech, 2014, 27(2):86-92.
7. Imagama S, Matsuyama Y, Yukawa Y, et al. C5 palsy after cervical laminoplasty:a multicenter study[J]. J Bone Joint Surg Br, 2010, 92 (3):393-400.
8. Katsumi K, Yamazaki A, Watanabe K, et al. Can prophylactic bilateral C4/C5 foraminotomy prevent postoperative C5 palsy after open-door laminoplasty? A prospective study[J]. Spine (Phila Pa 1976), 2012, 37(9):748-754.
9. Hojo Y, Ito M, Abumi K, et al. A late neurological complication following posterior correction surgery of severe cervical kyphosis[J]. Eur Spine J, 2011, 20(6):890-898.
10. Hashimoto M, Mochizuki M, Aiba A, et al. C5 palsy following anterior decompression and spinal fusion for cervical degenerative diseases[J]. Eur Spine J, 2010, 19(10):1702-1710.
11. Odate S, Shikata J, Yamamura S, et al. Extremely wide and asymmetric anterior decompression causes postoperative C5 palsy[J]. Spine (Phila Pa 1976), 2013, 38(25):2184-2189.
12. Chiba K, Toyama Y, Matsumoto M, et al. Segmental motor paralysis after expansive open-door laminoplasty[J]. Spine (Phila Pa 1976), 2002, 27(19):2108-2115.
13. Seichi A, Takeshita K, Kawaguchi H, et al. Postoperative expansion of intramedullary high-intensity areas on T2-weighted magnetic resonance imaging after cervical laminoplasty[J]. Spine (Phila Pa 1976), 2004, 29(13):1478-1482.
14. Fan DP, Schwartz DM, Vaccaro AR, et al. Intraoperative neurophysiologic detection of iatrogenic C5 nerve root injury during laminectomy for cervical compression myelopathy[J]. Spine (Phila Pa 1976), 2002, 27(22):2499-2502.
15. Komagata M, Nishiyama M, Endo K, et al. Prophylaxis of C5 palsy after cervical expansive laminoplasty by bilateral partial foraminotomy[J]. Spine J, 2004, 3(22):650-655.
16. 趙棟, 鄧樹才, 馬毅. 頸椎減壓術后C5神經根麻痹[J]. 中國骨與關節外科, 2011, 4(4):317-321.
17. Hosono N, Miwa T, Mukai Y, et al. Potential risk of thermal damage to cervical nerve Roots by a high-speed drill[J]. J Bone Joint Surg Br, 2009, 91 (11):1541-1544.
18. 余可誼, 邱貴興. 頸椎術后C_5神經根麻痹[J]. 脊柱外科雜志, 2004, 2(5):307-309.
19. Currier BL. Neurological complications of cervical spine surgery C5 palsy and intraoperative monitoring[J]. Spine (Phila Pa 1976), 2012, 37(5):E328-E334.
20. Sakaura H, Hosono N, Mukai Y, et al. C5 palsy after decompression surgery for cervical myelopathy[J]. Spine (Phila Pa 1976), 2003, 28(21):2447-2451.

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West China Medical Journal

頸椎減壓術后頸5神經根麻痹影響因素研究進展

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