• Yasushi Fujiwara, Hideki Manabe, Bunichiro Izumi, Hiroyuki Tanaka, Kazumi Kawai, and Nobuhiro Tanaka.
• *Department of Orthopedic Surgery, Hiroshima City Asa Hospital †Department of Anesthesia and Intensive Care, Hiroshima City Asa Hospital ‡Department of Orthopaedic Surgery, Institute of Biomedical & Health Sciences, Hiroshima University.
• J Spinal Disord Tech. 2015 Jul 1.

Study DesignProspective study.ObjectiveTo investigate the efficacy of transcranial electrically stimulated muscle evoked potentials (TcE-MsEPs) for predicting postoperative segmental upper extremity palsy following cervical laminoplasty.Summary Of Background DataPostoperative segmental upper extremity palsy, especially in the deltoid and biceps (so-called C5 palsy), is the most common complication following cervical laminoplasty. Some papers have reported that postoperative C5 palsy cannot be predicted by TcE-MsEPs, although others have reported that it can be predicted.MethodsThis study included 160 consecutive cases that underwent open door laminoplasty, and TcE-MsEP monitoring was performed in the biceps brachii, triceps brachii, abductor digiti minimi, tibialis anterior and abductor hallucis. A more than 50% decrease in the wave amplitude was defined as an alarm point. According to the monitoring alarm, interventions were performed, which include steroid administration, foraminotomies etc.ResultsPostoperative deltoid and biceps palsy occurred in five cases. Among the 155 cases without segmental upper extremity palsy, there were no monitoring alarms. Among the five deltoid and biceps palsy cases, three case had significant wave amplitude decrease in the biceps during surgery and palsy occurred when the patients awoke from anesthesia (acute type). In the other two cases where the palsy occurred two days after the operation (delayed type), there were no significant wave decreases. In all of the cases, the palsy was completely resolved within 6 months.DiscussionThe majority of C5 palsies have been reported to occur several days following surgery, but some of them have been reported to occur immediately after surgery. Our results demonstrated that TcE-MsEPs can predict the acute type, although the delayed type cannot be predicted.ConclusionsA more than 50% wave amplitude decrease in the biceps is useful to predict acute type segmental upper extremity palsy. Further examination about the interventions for monitoring alarm will be essential for preventing palsy.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivitives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. http://creativecommons.org/licenses/by-nc-nd/3.0.

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