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

Lubelski, Daniel; Pennington, Zach; Planchard, Ryan; Höke, Ahmet; Theodore, Nicholas; Sciubba, Daniel M.; Belzberg, Allan J.

doi:10.1016/j.spinee.2020.10.001

Cited by 4 publications

(2 citation statements)

References 34 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%

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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%

“…Lubelski et al 28 uncovered several EMG findings related to C5P recovery. During the 6-week to 6-month period after C5P onset, normal motor unit recruitment on EMG testing was predictive of complete recovery.…”

Section: Utility Of Radiographic Imaging and Emg In Determining C5p R...mentioning

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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Postoperative C5 Palsy: Apples, Oranges, and Rotten Tomatoes

2021

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Treatment of C5 Palsy: An International Survey of Peripheral Nerve Surgeons

Lubelski

Hersh

Feghali

et al. 2023

Global Spine Journal

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Study Design International survey. Objectives C5 palsy (C5P) is a neurological complication affecting 5-10% of patients after cervical decompression surgery. Most cases improve with conservative treatment; however, nearly 20% of patients may be left with residual deficits. Guidelines are lacking on C5P management and timing of surgical intervention. Therefore, we sought to survey peripheral nerve surgeons on their management of C5P. Methods An online survey was distributed centered around a patient with C5P after posterior cervical decompression and fusion. Questions included surgeon demographics, diagnostic modalities, and timing and choice of operation. Responses were summarized and the chi-squared and Kruskal-Wallis H tests were used to examine differences across specialties. Results A total of 154 surgeons responded to the survey, of which 59 (38%) indicated that they manage C5P cases. Average time prior to operating was 4.5 ± 2.2 months for complete injuries and 6.6 ± 3.2 months for partial injuries, with neurosurgeons significantly more likely to wait longer periods for complete ( P = .01) and partial injuries ( P = .03). Foraminotomies were selected by 19% of surgeons, while 92% selected nerve transfers. Transfer of the ulnar nerve to the musculocutaneous nerve was the most common choice (81%), followed by transfer of the radial nerve to the axillary nerve (58%). Conclusion Consensus exists among peripheral nerve surgeons on the use of nerve transfers for surgical treatment in cases with severe motor weakness failing to improve. Most surgeons advocate for early intervention in complete injuries. Disagreement concerns the type of nerve transfer employed, timing of surgery, and efficacy of foraminotomy.

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

Cited by 4 publications

References 34 publications

Defining postoperative C5 palsy and recovery: a systematic review

Defining postoperative C5 palsy and recovery: a systematic review

Postoperative C5 Palsy: Apples, Oranges, and Rotten Tomatoes

Treatment of C5 Palsy: An International Survey of Peripheral Nerve Surgeons

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