Epidemiology of C5 Palsy after Cervical Spine Surgery: A 21-Center Study

Abstract

ObjectiveC5 palsy is a severe complication after cervical spine surgery, the pathophysiology of which remains unclear. This multicenter study investigated the incidence of C5 palsy following cervical spine surgery in Korea. MethodsWe conducted a retrospective multicenter study involving 21 centers from the Korean Cervical Spine Study Group. The inclusion criteria were cervical spine surgery patients between 2012 and 2016, excluding cases of neck surgery. In patients with C5 palsy, the operative methods, disease category, onset time of C5 palsy, recovery time, C5 manual muscle testing (MMT) grade, and post-C5 palsy management were analyzed. ResultsWe collected 15,097 cervical spine surgery cases from 21 centers. C5 palsy occurred in 88 cases (0.58%). C5 palsy was more common in male patients (p=0.019) and after posterior approach procedures (p<0.001). C5 palsy usually occurred within 3 days after surgery (77 of 88, 87.5%) and most C5 palsy patients recovered within 6 months (51 of 88, 57.95%). Thirty C5 palsy patients (34.09%) had motor weakness, with an MMT grade≤2. Only four C5 palsy patients (4.5%) did not recover during follow-up. Posterior cervical foraminotomy was performed in 7 cases (7.95%), and steroids were used in 56 cases (63.63%). Twenty-six cases (29.55%) underwent close observation only. ConclusionThe overall incidence of C5 palsy was relatively low (0.58%). C5 palsy was more common after posterior cervical surgery and in male patients. C5 palsy usually developed within 3 days after surgery, and more than half of patients with C5 palsy recovered within 6 months.

Preoperative Radiological Parameters to Predict Clinical and Radiological Outcomes after Laminoplasty

“…Additionally, MR-based parameters, such as the occupying ratio, OPLL shape, and cord signal change have a significant impact on clinical outcomes. Complications of laminoplasty such as LCL, C5 palsy [ 49 ], postoperative neck pain, increased size of OPLL [ 70 ], decreased ROM, and insufficient decompression also affects clinical outcomes. In this regard, there is a limited degree to which clinical effects can be analyzed in terms of alignment factors alone.…”

A Novel Method of Making Hinges Using a Newly Designed Sharp Rongeur to Enhance Radiological and Clinical Outcomes in French‐Door Cervical Expansive Laminoplasty

“…The laminal open angle in the cervical laminoplasty is closely related to the prognosis, suggesting that the open angle should be less than 60° 6 . The excessive open angle may cause posterior spinal cord movement increasing the rates of post‐operative ANP and C5‐NRP 7,18 . In this study, the postoperative open angle in the rongeur group was significantly less than that in the drill group.…”

Phrenic nerve palsy after cervical laminectomy and fusion

“…C5 nerve palsy following cervical surgery occurs in up to 30% of cases, but the true incidence of phrenic nerve palsy following cervical surgery is not known [2] , [3] , [4] , [5] , [6] , [7] . This complication is associated with both anterior and posterior approaches, as well as with laminectomies and fusion.…”

“…Treatment entails surgical intervention with anterior cervical discectomy and fusion (ACDF), anterior cervical corpectomy and fusion (ACCF), posterior instrumented fusion with laminectomy, or laminoplasty. A well-known complication of these procedures is C5 nerve palsy, which manifests as deltoid and/or biceps brachii paralysis, and C5 dermatome pain or numbness [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] . While nerve palsy extending from C5 to C8 has been reported, pure phrenic nerve palsy is less common [15] , [16] , [17] .…”