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Spinal cord rotation may help predict patients at risk for C5 palsy

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SAN FRANCISCO — Among patients who developed a C5 nerve palsy after posterior cervical spine decompression, the presence of spinal cord rotation on preoperative MRIs may help surgeons predict who will develop the palsy, according to a speaker here.

Arunit J. Chugh presented study findings at the North American Spine Society Annual Meeting on behalf of investigators at University Hospitals Case Medical Center in Cleveland and at Case Western Reserve University School of Medicine. He explained that when the investigators classified mild spinal cord rotation as less than 6°, moderate rotation as 6° to 10° and severe rotation at greater than 10°, every patient who underwent a posterior decompression and had severe cord rotation developed C5 nerve palsy.

“As we had predicted, patients with posterior surgery showed a significant association between preoperative cord rotation and postoperative C5 palsy,” Chugh said.

For the study, the researchers defined C5 palsy as a deltoid motor strength reduction.

Arunit J. Chugh

According to study findings, there was a 7.3% prevalence of C5 palsy in the patients studied, who were all operated on from 2005 to 2012. There were 72 posterior procedures done from C4-6 and 77 anterior procedures were performed as controls. Among those, six C5 palsies developed in the posterior and five palsies developed in the anterior cases.

“The cord rotation in those with C5 palsy is significantly higher than those without a C5 palsy in both the anterior and posterior groups,” Chugh said.

A point-biserial correlation showed the association between the degree of cord rotation and C5 palsy was 0.58 for patients with an anterior decompression and 0.60 for patients with a posterior decompression, both of wish were significant, according to Chugh.

Spinal cord rotation had positive and negative predictive values of 0.57 and 0.97, respectively, according to the study findings. — by Susan M. Rapp

Reference:

Chugh AJ. Paper #86. Presented at: North American Spine Society Annual Meeting. Nov. 12-15, 2014; San Francisco.

Disclosure: Chugh has no relevant financial disclosures.