Pathogenesis of postoperative proximal upper limb paralysis following anterior decompression for treating single-level cervical disc herniation

WANG Hao; GONG Teng

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Medical Journal of the Chinese People Armed Police Forces ›› 2021, Vol. 32 ›› Issue (7) : 557-561.

Pathogenesis of postoperative proximal upper limb paralysis following anterior decompression for treating single-level cervical disc herniation

WANG Hao, GONG Teng

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Abstract

Objective To investigate the characteristics and risk factors of secondarily proximal upper limb paralysis (PULP) after anterior decompression of single-segment cervical disc herniation (CDH). Methods The clinical data on 235 patients with single segmental CDH treated with anterior cervical decompression combined with fusion or non-fusion fixation was analyzed retrospectively. The follow-up lasted more than 12 months. There were no significant differences in demographic data between the postoperative PULP group and non-PULP group. According to preoperative clinical manifestations, the patients were divided into two groups: the spinal cord injury group and the nerve root injury group. The decompression segments included C3/ 4, C4/5, C5/6 and C6/7 intervertebral spaces. The postoperative PULP incidence rates were compared between subgroups of different surgical segments or preoperative localized signs. The overall incidence of PULP after upper (lower) intervertebral horizontal decompression with the C5 vertebral body as the boundary was compared. Results All the 26 patients with PULP received non-surgical treatment after operation and achieved basic remission during the last follow-up. In addition to C4/5 intervertebral space and C5 myelomere, PULP could also be secondary to other segmental decompression. There was no significant difference in the incidence of PULP between superior(inferior) two intervertebral spaces with C5 vertebrae as the benchmark or four subaxial intervertebral spaces at the middle and lower level, respectively. The incidence of postoperative PULP among patients concomitant with preoperative myelopathy phenotype was higher than among those with nerve root phenotype, and the difference was of statistical significance. Conclusions Patients who present with predominantly upper motor neuron pathway damage before operation are more vulnerable to PULP after anterior decompression targeted at CDH. The onset of PULP is closely related to the early, reversible and temporary impairment of the system of propriospinal tracts and neurons.

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proximal upper limb paralysis / anterior surgery / preoperative clinical manifestation / cervical disc herniation / propriospinal tracts and neurons

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WANG Hao, GONG Teng. Pathogenesis of postoperative proximal upper limb paralysis following anterior decompression for treating single-level cervical disc herniation[J]. Medical Journal of the Chinese People Armed Police Forces. 2021, 32(7): 557-561

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