リハビリテーション経過中に生じた「術後第5頸髄節麻痺」の1例

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Postoperative C5 palsy is defined as paresis of the deltoid and/or biceps brachii muscle after cervical spine decompressive surgery without any worsening of myelopathic symptoms. Various sites of involvement, including radiculopathy and otherwise subclinical myelopathy, have been proposed for postoperative C5 palsy, but controversy persists. Postoperative C5 palsy generally carries a good prognosis for functional recovery, but some patients have a limited recovery with severe residual paresis. Here we report a patient with postoperative C5 palsy occurring during rehabilitation with poor motor recovery and compromised activities of daily living (ADL). A 76-year-old man who underwent cervical laminoplasty for myelopathy developed bilateral C5 palsy during postoperative rehabilitation. While an electrodiagnostic examination suggested radiculopathy as the major cause of palsy, the severity and poor recovery suggested double-crash syndrome with the anterior column as well as axonal injury. Postoperative C5 palsy may be difficult to recognize during rehabilitation, given limited experience, and the vast majority of postoperative C5 palsies occur within 1 week following surgery, generally followed by good functional recovery. However, some cases of palsy do indeed present during rehabilitation and these tend to have a poor prognosis. The present case under-scores the importance of recognizing postoperative C5 palsy during rehabilitation, precise assessment, and specific treatment of the palsy to maximally improve ADL.
社団法人日本リハビリテーション医学会の論文
2005-07-18

リハビリテーション経過中に生じた「術後第5頸髄節麻痺」の1例

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