• Hiroaki Onuma, Takashi Hirai, Kenichiro Sakai, Motonori Hashimoto, Hiroyuki Inose, Kentaro Yamada, Yu Matsukura, Shingo Morishita, Satoru Egawa, Jun Hashimoto, Kentaro Sakaeda, Satoshi Tamura, Ichiro Torigoe, Masaki Tomori, Kyohei Sakaki, Yutaka Kobayashi, Kazuyuki Otani, Kazuo Kusano, Norihiko Miyake, Tsuyoshi Yamada, Shuta Ushio, Shigeo Shindo, Yoshiyasu Arai, Atsushi Okawa, and Toshitaka Yoshii.
• Department of Orthopedic Surgery, Institute of Science Tokyo, Tokyo, Japan.
• Spine. 2024 Oct 23.

Study DesignRetrospective cohort study.ObjectiveTo investigate the incidence of and risk factors for segmental motor paralysis after anterior cervical spine surgery.Summary Of Background DataSegmental motor paralysis is a potential complication following both anterior and posterior cervical decompression procedures; however, previous studies investigating risk factors for segmental motor paralysis after anterior cervical spine surgery were limited by small sample sizes. Consequently, the exact pathogenesis and risk factors for this complication remain poorly understood, highlighting the need for larger-scale investigations focused exclusively on anterior cervical spine surgeries.MethodsWe retrospectively reviewed the clinico-demographic and operative factors and postoperative outcomes of 1,428 patients undergoing anterior cervical spine surgery at three spine centers in Japan. Postoperative segmental motor paralysis was defined as deterioration of upper extremity muscle strength by ≥1 grade; recovery was defined as a return to preoperative muscle strength levels. Univariate and multivariate analyses were performed to identify risk factors.ResultsNinety-nine patients (6.9%) developed segmental motor paralysis, mostly involving the C5 segment (81.8%), the incidence being highest in patients with ossification of the posterior longitudinal ligament (OPLL) and those undergoing anterior cervical corpectomy and fusion or hybrid fusion (discectomy + corpectomy). Older age, male sex, higher body mass index, OPLL, and cervical corpectomy were independent risk factors for paralysis, with these patients having significantly worse clinical outcomes at 1 year postoperatively. Most patients (74/99, 79.6%) regained preoperative muscle strength levels an final follow up.ConclusionThis study identified important clinico-demographic and operative risk factors for segmental motor paralysis after anterior cervical spine surgery. Patients undergoing corpectomy, with or without OPLL, were found to be at particularly high risk. While most patients recover well, worse outcomes with segmental motor paralysis highlight the importance of preventing this complication, particularly for OPLL patients and corpectomy procedures.Level Of EvidenceIII.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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