C5 palsy after cervical laminectomy: natural history in a 10-year series

Hofler, Ryan C.; Frazzetta, Joseph; Zakaria, Jehad; Aziz, Amany; Adams, William; Jones, Gary E.

doi:10.1016/j.spinee.2021.04.003

Cited by 7 publications

(2 citation statements)

References 24 publications

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“…Generally, recovery was based on extent of improvement in deltoid muscle strength, as shown in Table 3. 10,13,19,21,29,34,37,38 Complete recovery was commonly defined as achieving a grade of 5 on MMT, whereas less than 100% improvement on MMT was considered partial recovery. 10,13,37 However, 2 studies considered MMT grade 4 or higher to be adequate recovery, while 1 other study classified Medical Research Council (MRC) grade 3 or higher as useful recovery.…”

Section: C5p Recoverymentioning

confidence: 99%

Defining postoperative C5 palsy and recovery: a systematic review

Deshpande¹,

Stino

Smith

et al. 2023

Journal of Neurosurgery: Spine

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OBJECTIVE Postoperative C5 palsy (C5P) is a well-recognized and often-delayed complication of cervical spine surgery. Most patients recover within 6 months of onset, but the prognosis of severe cases is poor. The clinical significance and natural history of mild versus severe C5P appear to differ substantially, but palsy severity and recovery have been poorly characterized in the literature. METHODS Owing to the varying prognoses and expanding treatment options such as nerve transfer surgery to reconstruct the C5 myotome, this systematic review attempted to describe how C5P severity is classified and how C5P and its recovery are defined, with the aim of proposing a postoperative C5P scale to support clinical decision-making. PubMed was searched for articles in English published since 2000 that offer a clear definition of postoperative C5P or its recovery. Only articles reporting exclusively on C5 palsy for patients undergoing surgery for degenerative disease were included. A single reviewer screened titles and abstracts and reviewed the full text of relevant articles, with consultation as needed from a second reviewer. Data collected included postoperative C5P definitions, classification of C5P severity, and definition and/or classification of C5P recovery. Qualitative analysis was performed. RESULTS Full-text reviews were conducted of 98 of 272 articles identified and screened, and 43 met the inclusion criteria. Postoperative C5P was most commonly defined as a reduction in deltoid muscle strength by ≥ 1 grade using manual muscle testing (MMT), with potential biceps involvement also noted by some studies. The few studies that stratified C5P on the basis of severity unanimously characterized severe C5P as MMT grade ≤ 2. Nine studies reported on C5P recovery. Deltoid muscle strength improvement of MMT grade 5 commonly defined complete recovery, with no MMT improvement considered partial recovery. CONCLUSIONS This review identified clear discrepancies in the definitions of C5P and its recovery, leading to heterogeneity in its evaluation and management. With the emergence of therapeutic procedures for severe C5P, standardization of the definitions of C5P and its recovery is critical. The authors propose MMT grades of 4, 3, and ≤ 2 to classify C5P as mild, moderate, and severe, respectively, and grades of 5, 4, and 3 to classify recovery as complete, sufficient, and useful, respectively.

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Section: C5p Recoverymentioning

confidence: 99%

Defining postoperative C5 palsy and recovery: a systematic review

Deshpande¹,

Stino

Smith

et al. 2023

Journal of Neurosurgery: Spine

View full text Add to dashboard Cite

show abstract

“…Posteriorly based surgery also has limitations, including a higher overall rate of complications (up to 50%) when compared with the anterior approach 46 . Specific complications include infection and wound complications (12%), C5 nerve palsy (28%) 52 , and increased hospital length of stay 50,53 . Posterior reduction of dislocated facets in the setting of a traumatic large disc herniation is also a relative contraindication given the risk of neurologic deterioration.…”

Section: Operative Managementmentioning

confidence: 99%

Traumatic Cervical Facet Fractures and Dislocations

et al. 2022

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Flexion-distraction, axial loading, and rotational forces can cause various degrees of osseoligamentous disruption of the cervical spine, leading to traumatic cervical facet fractures and dislocations.Low-energy forces lead to minimally displaced facet fractures that often can be treated with immobilization only. High-energy forces are more likely to cause unstable injuries with or without neurologic compromise, which may require surgical intervention.The initial treatment of cervical facet injuries requires patient evaluation and management through the Advanced Trauma Life Support (ATLS) protocols, while definitive management varies based on the biomechanical components of the injury, the neurologic status of the patient, and additional patient factors.Cervical facet injuries often require a multidisciplinary approach to optimize long-term functional outcomes and minimize serious complications.

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An innovative approach to assess spinal canal expansion following French-door cervical laminoplasty by intraoperative ultrasonography

Lin

Chen

et al. 2023

Eur Radiol

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C5 palsy after cervical laminectomy: natural history in a 10-year series

Cited by 7 publications

References 24 publications

Defining postoperative C5 palsy and recovery: a systematic review

Defining postoperative C5 palsy and recovery: a systematic review

Traumatic Cervical Facet Fractures and Dislocations

An innovative approach to assess spinal canal expansion following French-door cervical laminoplasty by intraoperative ultrasonography

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