C5-, C6-radiculopathy as a complication of laminoplasty at the cervical spine level (clinical observation and a brief review of the literature)

INTRODUCTION. In some cases, after laminoplasty or anterior corporodesis, radiculopathy of the C5 root develops at the cervical level of the spine, the features of which are not reflected in the domestic literature, which may cause doctors difficulties in predicting its outcome and treatment.

AIM. To present our own observation of radiculopathy of two – C5 and C6 – roots after laminoplasty and laminectomy, its features and possible measures to prevent such a severe postoperative complication.

MATERIALS AND METHODS. The work is based on anamnesis, assessment of the dynamics of movements and sensitivity on a well-known five-point scale, pain – on a visual analogue scale, data from magnetic resonance imaging and electroneuromyography in a patient born in 1937, who was diagnosed in one of the institutions in St. Petersburg at the age of 85 years, laminoplasty of C3, C4, C6 and laminectomy of the C5 vertebrae were performed due to stenosis at this level.

RESULTS. The presented clinical and ENMG data indisputably indicated radiculopathy of the C5 and C6 roots associated with the operation of laminoplasty-laminectomy at the cervical level of the spine. The frequency of such complications, according to summary literature data, ranges from 0 to 30 %, averaging 5.6 %. Moreover, the more severe the degree of movement disorders, the slower the recovery occurs, taking from 3 to 12 months. At the same time, in 28 %, recovery is insufficient even after 55+17 months.

CONCLUSION. When performing laminoplasty and laminectomy for cervical spinal stenosis, there is a possibility of developing radiculopathy of the C5, C6 roots, for the prevention of which, taking into account the literature data, it is recommended: 1) before the operation, perform ENMG to identify signs of subcompensated suffering of the cervical roots in the operation area. Identification of such signs gives grounds to supplement laminoplasty with microforaminotomy at this level; 2) at the access stage, gently spread the neck muscles to the sides, followed by periodic weakening of their retraction; 3) when performing laminoplasty, limit the angle of spread of the arches within 15–30°, and during laminectomy, the width of the latter should not exceed the width of the spinal cord by more than 2–3 mm; 4) in cases of eliminating kyphosis, in order to avoid compression of the roots, pay attention to limiting the arc of lordosis formation. 

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