Abstract
To the editor:
Recently, we were honored to read Saumyajit et al ‘s article ' Comparing Spinal Cord Drift, Clinical Outcomes and C5 Palsy in Degenerative Cervical Myelopathy: A Study of Cervical Laminoplasty vs Laminectomy/Fusion. 1 This study not only compared the spinal cord drift of cervical laminoplasty and laminectomy combined with lateral mass screw fixation, but also evaluated the relationship between preoperative cervical alignment, postoperative spinal cord drift, functional results and the incidence of C5 palsy. It provides new insights for the clinical diagnosis and treatment of degenerative cervical spondylosis. Nevertheless, there are still some problems in this study that need to be further explored.
First of all, although the study explored the relationship between preoperative cervical curvature and postoperative spinal cord drift on C5 nerve palsy. However, the effect of the width of the cervical laminectomy on the incidence of spinal cord drift and C5 nerve palsy was lacking. Previous studies have shown that if too many laminae are removed at C5 during surgery, the risk of C5 nerve palsy will increase. The study also showed that increased preoperative spinal canal diameter was also associated with an increased risk of C5 paralysis. 2 The reason for this phenomenon may be that the removal of more lamina will increase the width of the spinal canal, resulting in an increase in the degree of spinal cord drift, pulling the C5 nerve. In addition, a systematic review pointed out that previous intervertebral foramen stenosis was also associated with postoperative C5 nerve palsy. 3 Secondly, the fixation position of the titanium plate is also related to C5 nerve paralysis after cervical spine surgery. Some studies have shown that when the titanium plate is fixed at the lamina edge, the incidence of C5 nerve paralysis is lower than that of the titanium plate fixed on the lateral mass. 4 The specific mechanism still needs further exploration by colleagues.
Finally. Despite the above questions, we are still very grateful for the author ‘s contribution in the field of surgical treatment of degenerative cervical spondylotic myelopathy. At the same time, it is hoped that our comments will help readers better read this article.
