Cervical Single Open-door Laminoplasty With The Unilateral C4/5Foraminotomy Influence On The C5Palsy

Objective:To evaluate the effectiveness of cervical single open-door laminoplasty with the Unilateral C4/C5foraminotomy for cervical myelopathy in preventing postoperative C5palsy. And to explore the mechanism of postoperative C5palsy, the relation of C5palsy and C4/5intervertebral foramen stenosis, and the prevention, treatment, and the prognosis of C5palsy.Method: We retrospective analyzed clinical data of the200consecutive patients with cervical myelopathy with unilateral C4/5foraminal stenosis from January2008to June2012in the Tianjin Union Medicine Centre. There are89patients underwent cervical single open-door laminoplasty combined with unilateral C4/5foraminotomy, these were designated as the A group. The rest111patients underwent simple cervical single open-door laminoplasty, and designated as the B group. All patients preoperative underwent X-rays, CT, MRI and other imaging studies, to assess the presence of unilateral C4/5intervertebral foramen stenosis. There was no significant differerce in age, gender, disease duration, segmental lesions and diagnosis of distribution between2group(P>0.05), and was comparable. Record the operation time, bleeding volume, the incidence of C5palsy. The Japanese Orthopaedic Association (JOA) score before and after operation was used for neurological assessment and calculated the JOA recovery rate.Result:There were1patient underwent the C5palsy, the incidence was1.12%in the A group, and be happen at the seventh day postoperative; and there were9patients with C5palsy in the group B, the incidence was8.11%, and be happen within one week postoperative. The mean C5palsy happen time is4.4days, and all the patients’C5palsy occurred in the open side. The incidence of C5palsy is significant difference between2group ((2=3.709, P=0.045). The A group’s operation time was122±29min and the bleeding volume was165±50ml. The B group’s was109±31min and145±32ml. A is much higher than B group(t=3.033, P=0.010; t=3.429, P=0.003). All patients were followed up, and the follow up time of A group was3-48months(25months on average), the time of B was4-50months,(27months on average). The JO A score was significant improved at2weeks and the last follow up after operation when compared with preoperative JOA score between2group(P<0.05). However, the JOA score of2points was no significant(P>0.05). Between group A and group B, no significant difference was found in JOA score and the recovery rate at each time(P>0.05). During the follow up, the2group without a long time persisten axial pain and obvious spinal instability and all patients recovered the normal life within six months.Conclusion: Cervical single open-door laminoplasty with unilateral C4/5foraminotomy can reduce the incidence of the C5palsy, for those cervical myelopathy patients who with unilateral C4/5foraminal stenosis reoperative. We conclude that cervical open-door laminoplasty with unilateral C4/5foraminotomy was the beneficial factor for postoperative C5palsy, and was an effective preventive measure against postoperative C5palsy after cervical laminoplasty. The C5palsy was used to the common complication of the cervical single open-door laminoplasty, the prognosis was usually good, most patients could have a good recovery by treatment conservatively.