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Preoperative Spinal Cord Damage Affects the Characteristics and Prognosis of Segmental Motor Paralysis After Cervical Decompression Surgery

Ikegami, Shota MD, PhD*; Tsutsumimoto, Takahiro MD, PhD; Ohta, Hiroshi MD, PhD; Yui, Mutsuki MD; Kosaku, Hidemi MD; Uehara, Masashi MD; Misawa, Hiromichi MD, PhD

doi: 10.1097/BRS.0000000000000175
Cervical Spine

Study Design. Retrospective analysis.

Objective. To test the hypothesis that preoperative spinal cord damage affects postoperative segmental motor paralysis (SMP).

Summary of Background Data. SMP is an enigmatic complication after cervical decompression surgery. The cause of this complication remains controversial. We particularly focused on preoperative T2-weighted high signal change (T2HSC) on magnetic resonance imaging in the spinal cord, and assessed the influence of preoperative T2HSC on SMP after cervical decompression surgery.

Methods. A retrospective review of 181 consecutive patients (130 males and 51 females) who underwent cervical decompression surgery was conducted. SMP was defined as development of postoperative motor palsy of the upper extremities by at least 1 grade in manual muscle testing without impairment of the lower extremities. The relationship between the locations of T2HSC in preoperative magnetic resonance imaging and SMP and Japanese Orthopedic Association score was investigated.

Results. Preoperative T2HSC was detected in 78% (142/181) of the patients. SMP occurred in 9% (17/181) of the patients. Preoperative T2HSC was not a significant risk factor for the occurrence of SMP (P = 0.682). However, T2HSC significantly influenced the severity of SMP: the number of paralyzed segments increased with an incidence rate ratio of 2.2 (P = 0.026), the manual muscle score deteriorated with an odds ratio of 8.4 (P = 0.032), and the recovery period was extended with a hazard ratio of 4.0 (P = 0.035). In patients with preoperative T2HSC, Japanese Orthopaedic Association scores remained lower than those in patients without T2HSC throughout the entire period including pre- and postoperative periods (P < 0.001).

Conclusion. Preoperative T2HSC was associated with worse severity of SMP in patients who underwent cervical decompression surgery, suggesting that preoperative spinal cord damage is one of the pathomechanisms of SMP after cervical decompression surgery.

Level of Evidence: 3

Segmental motor paralysis occurred in 9% of patients after cervical decompression surgery. Magnetic resonance imaging signal change in spinal cord was a factor associated with deterioration of the paralysis. The signal change was also a factor associated with deterioration of surgical outcome of cervical decompression surgery.

*Department of Orthopaedic Surgery, Shinshu University, School of Medicine, Matsumoto, Japan; and

Spine Center, Yodakubo Hospital, Nagawa, Nagano, Japan.

Address correspondence and reprint requests to Shota Ikegami, MD, PhD, Department of Orthopaedic Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto 390-8621, Nagano, Japan; E-mail:

Acknowledgment date: September 16, 2013. Revision date: November 11, 2013. Acceptance date: December 9, 2013.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

© 2014 by Lippincott Williams & Wilkins