Shoulder Traction as a Possible Risk Factor for C5 Palsy in Anterior Cervical Surgery: A Cadaveric Study
<i>Background and Objectives</i>: Many risk factors for postoperative C5 palsy (PC5P) have been reported regarding a “cord shift” after a posterior approach. However, there are few reports about shoulder traction as a possible risk factor of anterior cervical surgery. Therefore, we asses...
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MDPI AG
2024-09-01
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| author | Ja-Yeong Yoon Sung-Min Kim Seong-Hwan Moon Hak-Sun Kim Kyung-Soo Suk Si-Young Park Ji-Won Kwon Byung-Ho Lee |
| author_facet | Ja-Yeong Yoon Sung-Min Kim Seong-Hwan Moon Hak-Sun Kim Kyung-Soo Suk Si-Young Park Ji-Won Kwon Byung-Ho Lee |
| author_sort | Ja-Yeong Yoon |
| collection | DOAJ |
| description | <i>Background and Objectives</i>: Many risk factors for postoperative C5 palsy (PC5P) have been reported regarding a “cord shift” after a posterior approach. However, there are few reports about shoulder traction as a possible risk factor of anterior cervical surgery. Therefore, we assessed the stretched nerve roots when shoulder traction was applied on cadavers. <i>Materials and Methods</i>: Eight cadavers were employed in this study, available based on age and the presence of foramen stenosis. After dissecting the sternocleidomastoid muscle of the cadaver, the shoulder joint was pulled with a force of 2, 5, 8, 10, 15, and 20 kg. Then, the stretched length of the fifth nerve root was measured in the extra-foraminal zone. In addition, the same measurement was performed after cutting the carotid artery to accurately identify the nerve root’s origin. After an additional dissection was performed so that the superior trunk of the brachial plexus could be seen, the stretched length of the fifth and sixth nerve roots was measured again. <i>Results</i>: Throughout the entire experiment, the fifth nerve root stretched out for an average of 1.94 mm at 8 kg and an average of 5.03 mm at a maximum force of 20 kg. In three experiments, the elongated lengths of the C5 nerve root at 8 kg and 20 kg were 1.69/4.38 mm, 2.13/5.00 mm, and 0.75/5.31 mm, respectively, and in the third experiment, the elongated length of the C6 nerve root was 1.88/5.44 mm. <i>Conclusions</i>: Although this was a cadaveric experiment, it suggests that shoulder traction could be the risk factors for PC5P after anterior cervical surgery. In addition, for patients with foraminal stenosis and central stenosis, the risk would be higher. Therefore, the surgeon should be aware of this, and the patient would need sufficient explanation. |
| format | Article |
| id | doaj-art-b568972d44f845f790cc1e8c2d13767c |
| institution | OA Journals |
| issn | 1010-660X 1648-9144 |
| language | English |
| publishDate | 2024-09-01 |
| publisher | MDPI AG |
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| series | Medicina |
| spelling | doaj-art-b568972d44f845f790cc1e8c2d13767c2025-08-20T01:55:39ZengMDPI AGMedicina1010-660X1648-91442024-09-01609142910.3390/medicina60091429Shoulder Traction as a Possible Risk Factor for C5 Palsy in Anterior Cervical Surgery: A Cadaveric StudyJa-Yeong Yoon0Sung-Min Kim1Seong-Hwan Moon2Hak-Sun Kim3Kyung-Soo Suk4Si-Young Park5Ji-Won Kwon6Byung-Ho Lee7Department of Orthopaedic Surgery, Daejeon Sun Hospital, Daejeon 34811, Republic of KoreaDepartment of Orthopaedic Surgery, College of Medicine, Kyung-Hee University Hospital at Gangdong, Seoul 05278, Republic of KoreaDepartment of Orthopedic Surgery, Yonsei University College of Medicine, Seoul 03722, Republic of KoreaDepartment of Orthopedic Surgery, Yonsei University College of Medicine, Seoul 03722, Republic of KoreaDepartment of Orthopedic Surgery, Yonsei University College of Medicine, Seoul 03722, Republic of KoreaDepartment of Orthopedic Surgery, Yonsei University College of Medicine, Seoul 03722, Republic of KoreaDepartment of Orthopedic Surgery, Yonsei University College of Medicine, Seoul 03722, Republic of KoreaDepartment of Orthopedic Surgery, Yonsei University College of Medicine, Seoul 03722, Republic of Korea<i>Background and Objectives</i>: Many risk factors for postoperative C5 palsy (PC5P) have been reported regarding a “cord shift” after a posterior approach. However, there are few reports about shoulder traction as a possible risk factor of anterior cervical surgery. Therefore, we assessed the stretched nerve roots when shoulder traction was applied on cadavers. <i>Materials and Methods</i>: Eight cadavers were employed in this study, available based on age and the presence of foramen stenosis. After dissecting the sternocleidomastoid muscle of the cadaver, the shoulder joint was pulled with a force of 2, 5, 8, 10, 15, and 20 kg. Then, the stretched length of the fifth nerve root was measured in the extra-foraminal zone. In addition, the same measurement was performed after cutting the carotid artery to accurately identify the nerve root’s origin. After an additional dissection was performed so that the superior trunk of the brachial plexus could be seen, the stretched length of the fifth and sixth nerve roots was measured again. <i>Results</i>: Throughout the entire experiment, the fifth nerve root stretched out for an average of 1.94 mm at 8 kg and an average of 5.03 mm at a maximum force of 20 kg. In three experiments, the elongated lengths of the C5 nerve root at 8 kg and 20 kg were 1.69/4.38 mm, 2.13/5.00 mm, and 0.75/5.31 mm, respectively, and in the third experiment, the elongated length of the C6 nerve root was 1.88/5.44 mm. <i>Conclusions</i>: Although this was a cadaveric experiment, it suggests that shoulder traction could be the risk factors for PC5P after anterior cervical surgery. In addition, for patients with foraminal stenosis and central stenosis, the risk would be higher. Therefore, the surgeon should be aware of this, and the patient would need sufficient explanation.https://www.mdpi.com/1648-9144/60/9/1429C5 palsyshoulder tractioncadaveric studyanterior approachextraforaminalextradural |
| spellingShingle | Ja-Yeong Yoon Sung-Min Kim Seong-Hwan Moon Hak-Sun Kim Kyung-Soo Suk Si-Young Park Ji-Won Kwon Byung-Ho Lee Shoulder Traction as a Possible Risk Factor for C5 Palsy in Anterior Cervical Surgery: A Cadaveric Study Medicina C5 palsy shoulder traction cadaveric study anterior approach extraforaminal extradural |
| title | Shoulder Traction as a Possible Risk Factor for C5 Palsy in Anterior Cervical Surgery: A Cadaveric Study |
| title_full | Shoulder Traction as a Possible Risk Factor for C5 Palsy in Anterior Cervical Surgery: A Cadaveric Study |
| title_fullStr | Shoulder Traction as a Possible Risk Factor for C5 Palsy in Anterior Cervical Surgery: A Cadaveric Study |
| title_full_unstemmed | Shoulder Traction as a Possible Risk Factor for C5 Palsy in Anterior Cervical Surgery: A Cadaveric Study |
| title_short | Shoulder Traction as a Possible Risk Factor for C5 Palsy in Anterior Cervical Surgery: A Cadaveric Study |
| title_sort | shoulder traction as a possible risk factor for c5 palsy in anterior cervical surgery a cadaveric study |
| topic | C5 palsy shoulder traction cadaveric study anterior approach extraforaminal extradural |
| url | https://www.mdpi.com/1648-9144/60/9/1429 |
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