The incidence of C5?C6 radiculopathy as a complication of extensive cervical decompression: own results and review of literature

Abstract

This retrospective study aims to discuss and compare our results with those previously mentioned in the literature with regard to C5-C6 radiculopathy that occurs after decompression carried out for cervical spondylotic myelopathy. There are few reports in the literature referring to the incidence of the C5-C6 radiculopathy following cervical decompression procedures. Some authors believe that the postoperative cord shift is the most likely cause. From January 1994 to November 2002, 121 patients underwent cervical corpectomies for cervical spondylotic myelopathy. The preoperative and the postoperatively discovered paresis have been assessed according to the criteria of the British Medical Council. The Nurick Scale was used to grade the severity of the myelopathic changes. The follow-up period varied from 4 to 111 months with an average of 50 months. Symptoms of C5 and/or C6 radiculopathy appeared in 10 patients (8.2%) postoperatively. Aggravation of a preoperative C5 and/or C6 radiculopathy was seen in 3 patients, while 7 patients developed a new C5 and/or C6 radiculopathy in the immediate postoperative period. These motor deficits resolved completely in 7 patients within 7 months of surgery, whereas a residual motor weakness remained in the other 3 patients. The postoperative C5 motor deficit is not infrequently associated with partial involvement of the C6 root. The lesions can be either unilateral or bilateral with a statistically average frequency of 8%. The prognosis is generally favorable. Our results did not support the hypothesis that the claimed cord shift phenomenon is a possible aetiology.

Efficacy of intraoperative monitoring of transcranial electrical stimulation–induced motor evoked potentials and spontaneous electromyography activity to identify acute-versus delayed-onset C-5 nerve root palsy during cervical spine surgery

“…The overall rate of new-onset postoperative deltoid muscle weakness in our investigation (5.2%) is consistent with previously reported estimates. 2,3,[5][6][7][8][9]11,14,19,26,27 Analysis of the 12 patients who presented with postoperative deltoid weakness revealed several notable trends. First, the potential for C-5 nerve root injury increased significantly in the setting of a C-4 and/or C-5 corpectomy versus single-or multilevel discectomy without corpectomy.…”

“…3,4,[7][8][9]14,16,18,19,24,25 For both single-and multilevel anterior procedures involving the C-4 and C-5 spinal levels, but without corpectomy, the incidence of C-5 nerve root injury was ≤ 1%. The incidence of weakness in patients who had undergone a corpectomy at C-4 but not at C-5 or at C-5 but not at C4 was similar to rates reported in the literature for anterior cervical spine surgeries.…”

“…The reported incidence of iatrogenic C-5 palsy ranges from 1.6% to 12.1% (mean = 4.3%) for anterior cervical fusion 2,5,6,11,27 and from 0% to 30% (mean = 4.7%) for posterior laminoplasty/laminectomy. 3,4,[7][8][9]14,19,26 In most cases, the prognosis for complete recovery from deltoid and/or biceps brachii muscle weakness is good; however, the percentage of patients with persistent deficit even a year or more after injury is high enough to warrant greater concern for early identification of evolving injury such that rescue intervention can be initiated intraoperatively. [7][8][9]14,16,18,19,24 Recently, Hashimoto et al 9 analyzed the clinical and MRI findings of patients who experienced C-5 nerve root palsy following ACD with fusion in an effort to identify distinguishing characteristics that may explain the cause of this complication, as well as alert the spine surgeon as to which patients should be viewed as high risk.…”

“…3,4,[7][8][9]14,19,26 In most cases, the prognosis for complete recovery from deltoid and/or biceps brachii muscle weakness is good; however, the percentage of patients with persistent deficit even a year or more after injury is high enough to warrant greater concern for early identification of evolving injury such that rescue intervention can be initiated intraoperatively. [7][8][9]14,16,18,19,24 Recently, Hashimoto et al 9 analyzed the clinical and MRI findings of patients who experienced C-5 nerve root palsy following ACD with fusion in an effort to identify distinguishing characteristics that may explain the cause of this complication, as well as alert the spine surgeon as to which patients should be viewed as high risk. Among their conclusions was the suggestion that intraoperative neuromonitoring coupled with an improved surgical technique might serve the dual purpose of minimizing C-5 nerve root injury subsequent to cervical decompression and helping to further elucidate the underlying etiology of this potentially incapacitating complication.…”

A systematic review of clinical and surgical predictors of complications following surgery for degenerative cervical myelopathy

“…Twenty-seven additional papers reported on predictors of complications but did not use an adequate multivariate statistical analysis. The following is a summary of the primary outcomes of these studies: postoperative complications (n = 4); 20,27,50,52 nerve root palsy (n = 8); [7][8][9]12,31,42,49,53 radiculopathy (n = 3); 24,40,67 shoulder stiffness and neck pain (n = 1); 76 instability (n = 1); 25 postoperative kyphosis (n = 2); 34,64 axial pain (n = 3); 54,55,61 pseudarthrosis (n = 1); 16 graft dislodgement (n = 2); 16,45 closure of lamina (n = 2); 51,68 and reconstruction failure (n = 1). 56 For KQ2, a total of 28 therapeutic cohort studies (2 randomized control trials, 11 prospective, 15 retrospective) met our inclusion criteria.…”