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LETTER TO EDITOR
Year : 2013  |  Volume : 61  |  Issue : 6  |  Page : 695-696

Drop finger as an adjacent segment disease after cervical expansive laminoplasty


1 Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
2 Department of Orthopedic Surgery, Chiba Aoba Municipal Hospital, Chiba, Japan
3 Department of Orthopedic Surgery, University of Tsukuba, Tsukuba, Japan

Date of Submission02-Nov-2013
Date of Decision23-Nov-2013
Date of Acceptance21-Dec-2013
Date of Web Publication20-Jan-2014

Correspondence Address:
Masao Koda
Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba
Japan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.125399

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How to cite this article:
Koda M, Furuya T, Rokkaku T, Yamazaki M, Murakami M, Takahashi K, Mannoji C. Drop finger as an adjacent segment disease after cervical expansive laminoplasty. Neurol India 2013;61:695-6

How to cite this URL:
Koda M, Furuya T, Rokkaku T, Yamazaki M, Murakami M, Takahashi K, Mannoji C. Drop finger as an adjacent segment disease after cervical expansive laminoplasty. Neurol India [serial online] 2013 [cited 2019 Dec 14];61:695-6. Available from: http://www.neurologyindia.com/text.asp?2013/61/6/695/125399


Sir,

We would like to report two cases showing drop finger as an adjacent segment disease after cervical expansive laminoplasty.

Case 1: The first case is about a 71-year-old male with complained of acute right finger drop 3 years after C3-C7 laminoplasty. He could not extend his metacarpophalangeal joint of right finger. Magnetic resonance imaging (MRI) and computerized tomography myelogram revealed a right C7-Th1 foraminal stenosis caused by osteoarthritis of facet joint [Figure 1]. A plain radiogram showed limitation of motion in C3-C7 (35.6° pre-operatively and 22.2° post-operatively). Electromyogram showed neurogenic discharge in extensor digitorum communis muscle and hand intrinsic muscles. The patient refused for the surgical option. The symptoms remain unchanged.
Figure 1: Post - operative magnetic resonance imaging (MRI) and pre - and post - operative computerized tomography (CT) myelogram. Although the mid - sagittal T2-weighted MRI showed a sufficient decompression of the spinal cord (a) paramedian sagittal MRI revealed a right C7-Th1 foraminal stenosis (b) post - operative CT myelogram showed right C7 - Th1 level foraminal stenosis caused by osteoarthritis of facet joint (d, arrow)

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Case 2: A 64-year-old woman complained of finger drop of her right hand 2 years after C3-C7 laminoplasty. MRI revealed a right C7-Th1 foraminal stenosis. Plain radiograms showed limitation of motion in C3-C7. The patient refused surgical option. The symptoms remain unchanged.

Both patients showed a limitation of range of motion at C3-C7 after laminoplasty. Previous reports described that the cervical range of motion is limited to approximately half of the pre-operative range of motion after laminoplasty. [1] Limitation of range of motion might induce degeneration of adjacent motion segments. Therefore, spinal surgeons should be conscious that adjacent segment disease could occur not only after anterior corpectomy, but also after laminoplasty. [2],[3] Because laminoplasty is generally performed at the C3-C7 level, physical stress concentrates to the C7-Th1 level, possibly results in adjacent segment disease at C7-Th1 level inducing C8 radiculopathy. The other potential pitfall is the diagnosis of C8 radiculopathy. As we previously reported, C8 radiculopathy can cause drop finger; however, it is not widely recognized amongst spinal surgeon. [4] The salience for the diagnosis of C8 radiculopathy is a concomitant hand intrinsic weakness with drop finger. Those symptoms are useful for early differential diagnosis with peripheral nerve lesions including posterior interosseous nerve palsy. Electromyograms might be supportive for diagnosis, by showing the neurogenic discharge in extensor digitorum communis and intrinsic hand muscles.

Although the natural course of drop finger caused by adjacent segment disease after laminoplasty is still unclear, there is a possibility that early surgery is needed because the present cases showed no recovery after conservative treatment.

 
  References Top

1.Kawakami M, Tamaki T, Ando M, Yamada H, Matsumoto T, Yoshida M. Preoperative instability does not influence the clinical outcome in patients with cervical spondylotic myelopathy treated with expansive laminoplasty. J Spinal Disord Tech 2002;15:277-83.  Back to cited text no. 1
[PUBMED]    
2.Wang MY, Green BA, Vitarbo E, Levi AD. Adjacent segment disease: An uncommon complication after cervical expansile laminoplasty: Case report. Neurosurgery 2003;53:770-2.  Back to cited text no. 2
[PUBMED]    
3.Wada K, Hatta S, Murata Y, Kato Y. Adjacent segment disease following C3-C7 en block laminoplasty and long-term follow-up of surgical treatment by T1-T3 laminoplasty. J Orthop Sci 2012.  Back to cited text no. 3
    
4.Koda M, Rokkaku T, Murakami M, Yamazaki M. Drop finger caused by 8 th cervical nerve root impairment: A report of six cases. Acta Neurochir (Wien) 2013;155:941-2.  Back to cited text no. 4
[PUBMED]    


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This article has been cited by
1 Drop finger caused by 8th cervical nerve root impairment: a clinical case series
Masao Koda,Takeo Furuya,Tomoyuki Rokkaku,Masazumi Murakami,Yasushi Ijima,Junya Saito,Mitsuhiro Kitamura,Seiji Ohtori,Sumihisa Orita,Kazuhide Inage,Masashi Yamazaki,Chikato Mannoji
European Spine Journal. 2017; 26(4): 1096
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