• Pain physician · Nov 2022

    Observational Study

    Postoperative Upper-limb Palsy After Posterior Percutaneous Endoscopic Cervical Foraminotomy and Discectomy.

    • Weiheng Wang, Liang Tang, Gonghao Zhang, Bing Xiao, Yanhai Xi, Xin Gu, and Xiaojian Ye.
    • Department of Orthopaedics, Second Affiliated Hospital of Naval Medical University, Shanghai, China.
    • Pain Physician. 2022 Nov 1; 25 (8): E1289E1296E1289-E1296.

    BackgroundPostoperative upper-limb palsy (ULP) is a serious complication after cervical spine surgery. ULP after posterior percutaneous endoscopic cervical foraminotomy and discectomy (PPCED) has not yet been reported.ObjectiveTo introduce cases of postoperative ULP after PPCED and associated risk factors.Study DesignA single-center, retrospective, observational study.SettingShanghai Changzheng Hospital, Naval Medical University, Shanghai, China.MethodsFrom January 2016 through January 2022, PPCED involving a total of 663 segments was performed in 610 patients with radiculopathy who were diagnosed with cervical radiculopathy or mixed cervical spondylosis caused by foraminal stenosis or posterolateral disc herniation.ResultsPPCED was successfully completed in 610 patients, 6 of whom (0.98%) developed ULP. Two patients were diagnosed with double-segment cervical nerve root canal stenosis (C4/5/6, C5/6/7) and 2 with migrated cervical disc soft herniation (a magnetic resonance image of one showed a migrated disc herniation downward from C4/5 in the sagittal plane; another showed this upward from C5/6); one patient was diagnosed with C5/6 intervertebral foraminal stenosis, and one had simple C4/5 lateral disc herniation. Postoperative ULP rates for C4/5 (2/30, 6.67%) and C5/6 (2/177, 1.13%) were much higher than those for the other levels. Anatomically, the width of the intervertebral foramen on computed tomography was 2.3 ± 1.12 mm in ULP cases, which was significantly lower than that in non-ULP cases (3.4 ± 1.83, P < 0.05). This suggests that preoperative foramen width correlates highly negatively with postoperative ULP incidence.LimitationsThis was a single-center, retrospective, nonrandomized study with a low level of evidence.ConclusionsPPCED is a good treatment for cervical radiculopathy. The rate of postoperative ULP after PPCED is much lower than that after posterior cervical foraminotomy. Perturbation to the C5 (or C6) nerve root, thermal injury due to burr use or the radiofrequency applied, and marked foraminal stenosis are possible relevant factors associated with postoperative ULP.

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