Journal article
Intraoperative Shoulder Traction as Cause of C5 Palsy: Magnetic Resonance Imaging Study
World neurosurgery, Vol.136, pp.e393-e397
04/2020
DOI: 10.1016/j.wneu.2020.01.024
PMID: 31931248
Abstract
During surgery, shoulder traction is often used for better fluoroscopic imaging of the lower cervical spine. Traction on the C5 root has been implicated as a potential cause of C5 palsy after cervical spine surgery. Using magnetic resonance imaging, this study was undertaken to determine the impact of upper extremity traction on the C5 root orientation.
In this study, 5 subjects underwent coronal magnetic resonance imaging of the cervical spine and left brachial plexus. Using a wrist restraint, sequential traction on the left arm with 10, 20, and 30 lb. was applied. Measurements of the angle between the spinal axis and C5 nerve root and the angle between the C5 nerve root and the upper trunk of the brachial plexus were obtained. The measurements were taken by a trained neuroradiologist and analyzed for significance.
The angle between the C5 nerve root and the vertical spinal axis remained within 3 and 4 degrees of the mean and was not found to be associated with increased traction weight (P = 0.753). The angle between the C5 root and the upper trunk increased with increasing weight and was found to be statistically significant (P = 0.003).
While the cause of C5 palsy is likely multifactorial, this study provides evidence that, in the awake volunteer, upper extremity traction leads to C5 root and upper trunk tension. These results suggest that shoulder traction in the anesthetized patient could lead to tension of the C5 nerve root and subsequent injury and palsy.
Details
- Title: Subtitle
- Intraoperative Shoulder Traction as Cause of C5 Palsy: Magnetic Resonance Imaging Study
- Creators
- Royce W Woodroffe - University of IowaLogan C Helland - Roy J. and Lucille A. Carver College of MedicineAdam Bryant - Roy J. and Lucille A. Carver College of MedicineKirill V Nourski - Roy J. and Lucille A. Carver College of MedicineSatoshi Yamaguchi - University of IowaLiesl Close - Roy J. and Lucille A. Carver College of MedicineJennifer Noeller - University of IowaNahom Teferi - Roy J. and Lucille A. Carver College of MedicineJoan E Maley - University of IowaPatrick W Hitchon - Roy J. and Lucille A. Carver College of Medicine
- Resource Type
- Journal article
- Publication Details
- World neurosurgery, Vol.136, pp.e393-e397
- DOI
- 10.1016/j.wneu.2020.01.024
- PMID
- 31931248
- NLM abbreviation
- World Neurosurg
- ISSN
- 1878-8750
- eISSN
- 1878-8769
- Publisher
- Elsevier Inc
- Language
- English
- Date published
- 04/2020
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Radiology; Iowa Neuroscience Institute; Neurosurgery; Otolaryngology
- Record Identifier
- 9984256835902771
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