Electrodiagnostic findings in postoperative C5 palsy after cervical laminectomy and fusion

Tucker, Alexander M.; Wallbom, Agnes; Darling, Marissa; Nguyen, David C; Everson, Richard; Terterov, Sergei; Nastasi, Anne; Langevin, Jean-Philippe

doi:10.1016/j.inat.2018.05.012

Cited by 3 publications

(1 citation statement)

References 3 publications

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“…62 Postoperative EMG recordings have shown promise in assisting in C5P diagnosis and predicting likelihood of recovery. 28,63,64 Several definitions of C5P were identified in this systematic review. Although a decrease in deltoid strength of at least 1 grade on MMT was the most common criterion, less than half of all studies (47%) used this definition (Table 4).…”

Section: Discussionmentioning

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: Discussionmentioning

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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Use of electromyography to predict likelihood of recovery following C5 palsy after posterior cervical spine surgery

et al. 2021

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C5 Palsy After Cervical Spine Decompression: Topographic Correlation With C6 Chassaignac Tubercle?

Rajabian

Quraishi²

2020

Spine

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Study Design. Cadaveric study on fresh unprocessed, nonpreserved, undyed specimens, which has not previously been reported. Objective. Our aim was to explore the possible topographic correlation of the C5 nerve root with regards to its course and regional relation to C6 Chassaignac tubercle. Summary of Background Data. C5 palsy is reported amongst the most frequent postoperative complications of cervical spinal procedures. We hypothesized that etiologic mechanisms proposed thus far in the current literature, although with some plausible explanation, still cannot explain why the C5 nerve root and not any other level suffer a postoperative palsy. Methods. Six fresh cadavers had extensive layer by layer dissection performed by two surgeons (one of whom has experience as an anatomy demonstrator and dissector). Roots of brachial plexus were exposed in relation to cervical transverse processes. Photographs were taken at each stage of the exposure. Results. We observed a close relation of the path of the C5 nerve root with the C6 tubercle bilaterally. Moreover, we noted a steeper descent of C5 in comparison with the other adjacent roots. Conclusion. Steeper angle of the C5 nerve root and close proximity to C6 Chassaignac tubercle may play a role in predisposing it to neuropraxia. Detailed anatomical photographs on fresh unprocessed cadaveric specimens are novel. Peculiar anatomical features and recent experimental evidence discussed do highlight a postganglionic extraforaminal etiology corresponding well to the demographic meta-analysis data on clinical features of postoperative C5 palsy. Exploring an alternative unified “neurophysiologic stress and critical tipping point” etiological model that encompasses current theories and correlates known metanalyses observations, we believe further studies would be prudent to ascertain/refute these findings. Level of Evidence: 3

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Electrodiagnostic findings in postoperative C5 palsy after cervical laminectomy and fusion

Cited by 3 publications

References 3 publications

Defining postoperative C5 palsy and recovery: a systematic review

Defining postoperative C5 palsy and recovery: a systematic review

Use of electromyography to predict likelihood of recovery following C5 palsy after posterior cervical spine surgery

C5 Palsy After Cervical Spine Decompression: Topographic Correlation With C6 Chassaignac Tubercle?

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