C5 Nerve root palsies following cervical spine surgery: A review

Abstract

Background:Cervical C5 nerve root palsies may occur in between 0% and 30% of routine anterior or posterior cervical spine operations. They are largely attributed to traction injuries/increased cord migration following anterior/posterior decompressions. Of interest, almost all studies cite spontaneous resolution of these deficits without surgery with 3–24 postoperative months.Methods:Different studies cite various frequencies for C5 root palsies following anterior or posterior cervical spine surgery. In their combined anterior/posterior series involving C4-C5 level decompressions, Libelski et al. cited up to a 12% incidence of C5 palsies. In Gu et al. series, C5 root palsies occurred in 3.1% of double-door laminoplasty, 4.5% of open-door laminoplasty, and 11.3% of laminectomy. Miller et al. observed an intermediate 6.9% frequency of C5 palsies followed by posterior cervical decompressions and fusions (PCDF).Results:Gu et al. also identified multiple risk factors for developing C5 palsies following posterior surgery; male gender, ossification of the posterior longitudinal ligament (OPLL), narrower foramina, laminectomy, and marked dorsal spinal cord drift. Miller et al. also identified an average $1918 increased cost for physical/occupational therapy for patients with C5 palsies.Conclusions:The incidence of C5 root deficits for anterior/posterior cervical surgery at C4-C5 was 12% in one series, and ranged up to 11.3% for laminectomies, while others cited 0–30%. Although identification of preoperative risk factors for C5 root deficits may help educate patients regarding these risks, there is no clear method for their avoidance at this time.

C5 nerve palsy after posterior reconstruction surgery: predictive risk factors of the incidence and critical range of correction for kyphosis

“…However, in all cases from the present series, the symptom of C5 palsy and the timing of the onset were typical, i.e., impairment of deltoid and biceps occurred several days after surgery without any sensory disturbance and severe girdle pain, as the previous authors had reported. Moreover, our results showed that all cases exhibited recovery from muscle weakness either fully or partially during the follow-up period, and that was also compatible with the recent review article [25]. Therefore, we would say that the possibility of contamination by other neurological pathologies such as motor neuron diseases and Parsonnage-Turner syndrome would be quite low in this series.…”

Neuromonitoring in Cervical Spine Surgery: When Is a Signal Drop Clinically Significant?

“…We found an incidence of 6% in C5 palsy, which was also within the previously reported range of 0%-30% [22][23][24][25]. No correlation was found between occurrence of C5 palsy and positive IONM signal alerts (p=0.73).…”

Should evoked potential monitoring be used in degenerative cervical spine surgery? A systematic review

“…In the evaluation presented herein, nerve root injuries were the most frequent postoperative neurological deficits. A study reported that the incidence of C5 root deficits for the anterior and posterior approach in decompression at C4–C5 level was 12% [9]. C5 palsy was commonly caused by iatrogenic injury, reperfusion injury of the spinal cord, or impingement by an osteophyte with a tethering effect.…”