C5 Palsy in Cervical Decompression Surgeries: A Study in 390 Patients
30 June 2016
01 July 2016
23 August 2016 (eFirst)
Introduction C5 palsy following cervical decompression is a known complication. The exact incidence is unclear, due to varying definitions in literature. C5 palsy is associated with significant morbidity due to weakness of deltoid/biceps.
Aim To report incidence of postoperative C5 palsy in cervical decompression surgeries for myelopathy and its correlation with demographic factors, etiology, radiological factors, and to assess recovery of palsy.
Materials and Methods All patients who underwent cervical decompression surgeries from 2006 to 2015 in a single institute were reviewed. A postoperative decrease by ≥ 1 manual muscle testing grade in only C5 myotome (deltoid/biceps/both) is taken as positive. Demographic, radiological, surgical factors resulting in C5 palsy and time of onset, duration of symptoms, and degree of recovery were noted.
Results A total of 390 patients were included in the study. Out of which, 232 patients underwent anterior while 158 had posterior surgeries. In all, 72 patients had ossification of the posterior longitudinal ligament (OPLL) and rest had spondylotic myelopathy. Incidence of palsy was 6.3% and mean onset of palsy was 2.8 days. Mean duration for recovery was 6.3 months with near complete recovery seen in majority of the patients (9/10). No significant relation was noted with age, preoperative Japanese Orthopedic Association score, change in cervical lordosis, and C45 intervertebral angle. Posterior surgeries, laminectomy, C45 foraminal stenosis, and OPLL were seen as risk factors for C5 palsy.
Conclusion Cervical decompression surgeries are relatively safe, with a small risk of C5 palsy. Though majority of patients recover with conservative treatment, preoperative counseling of this complication has to be explained.
- 1 Keegan JJ. The cause of dissociated motor loss in the upper extremity with cervical spondylosis. J Neurosurg 1965; 23 (5) 528-536
- 2 Scoville WB. Cervical spondylosis treated by bilateral facetectomy and laminectomy. J Neurosurg 1961; 18: 423-428
- 3 Stoops WL, King RB. Neural complications of cervical spondylosis: their response to laminectomy and foramenotomy. J Neurosurg 1962; 19: 986-999
- 4 Satomi K, Nishu Y, Kohno T, Hirabayashi K. Long-term follow-up studies of open-door expansive laminoplasty for cervical stenotic myelopathy. Spine 1994; 19 (5) 507-510
- 5 Zhao X, Xue Y, Pan F , et al. Extensive laminectomy for the treatment of ossification of the posterior longitudinal ligament in the cervical spine. Arch Orthop Trauma Surg 2012; 132 (2) 203-209
- 6 Guzman JZ, Baird EO, Fields AC , et al. C5 nerve root palsy following decompression of the cervical spine: a systematic evaluation of the literature. Bone Joint J 2014; 96-B (7) 950-955
- 7 Miller JA, Lubelski D, Alvin MD, Benzel EC, Mroz TE. C5 palsy after posterior cervical decompression and fusion: cost and quality-of-life implications. Spine J 2014; 14 (12) 2854-2860
- 8 Hasegawa K, Homma T, Chiba Y. Upper extremity palsy following cervical decompression surgery results from a transient spinal cord lesion. Spine 2007; 32 (6) E197-E202
- 9 Tanaka N, Nakanishi K, Fujiwara Y, Kamei N, Ochi M. Postoperative segmental C5 palsy after cervical laminoplasty may occur without intraoperative nerve injury: a prospective study with transcranial electric motor-evoked potentials. Spine 2006; 31 (26) 3013-3017
- 10 Hojo Y, Ito M, Abumi K , et al. A late neurological complication following posterior correction surgery of severe cervical kyphosis. Eur Spine J 2011; 20 (6) 890-898
- 11 Wang H, Zhang X, Lv B , et al. Analysis of correlative risk factors for C5 palsy after anterior cervical decompression and fusion. Int J Clin Exp Med 2015; 8 (3) 3983-3991
- 12 Minoda Y, Nakamura H, Konishi S , et al. Palsy of the C5 nerve root after midsagittal-splitting laminoplasty of the cervical spine. Spine 2003; 28 (11) 1123-1127
- 13 David KS, Rao RD. Bilateral C5 motor paralysis following anterior cervical surgery—a case report. Clin Neurol Neurosurg 2006; 108 (7) 675-681
- 14 Saunders RL. On the pathogenesis of the radiculopathy complicating multilevel corpectomy. Neurosurgery 1995; 37 (3) 408-412 , discussion 412–413
- 15 Hatta Y, Shiraishi T, Hase H , et al. Is posterior spinal cord shifting by extensive posterior decompression clinically significant for multisegmental cervical spondylotic myelopathy?. Spine 2005; 30 (21) 2414-2419
- 16 Shiozaki T, Otsuka H, Nakata Y , et al. Spinal cord shift on magnetic resonance imaging at 24 hours after cervical laminoplasty. Spine 2009; 34 (3) 274-279
- 17 Yonenobu K, Hosono N, Iwasaki M, Asano M, Ono K. Neurologic complications of surgery for cervical compression myelopathy. Spine 1991; 16 (11) 1277-1282
- 18 Currier BL. Neurological complications of cervical spine surgery: C5 palsy and intraoperative monitoring. Spine 2012; 37 (5) E328-E334
- 19 Radcliff KE, Limthongkul W, Kepler CK , et al. Cervical laminectomy width and spinal cord drift are risk factors for postoperative C5 palsy. J Spinal Disord Tech 2014; 27 (2) 86-92
- 20 Imagama S, Matsuyama Y, Yukawa Y , et al; Nagoya Spine Group. C5 palsy after cervical laminoplasty: a multicentre study. J Bone Joint Surg Br 2010; 92 (3) 393-400
- 21 Sasai K, Saito T, Akagi S, Kato I, Ohnari H, Iida H. Preventing C5 palsy after laminoplasty. Spine 2003; 28 (17) 1972-1977
- 22 Yanase M, Matsuyama Y, Mori K , et al. Intraoperative spinal cord monitoring of C5 palsy after cervical laminoplasty. J Spinal Disord Tech 2010; 23 (3) 170-175
- 23 Komagata M, Nishiyama M, Endo K, Ikegami H, Tanaka S, Imakiire A. Prophylaxis of C5 palsy after cervical expansive laminoplasty by bilateral partial foraminotomy. Spine J 2004; 4 (6) 650-655
- 24 Hosono N, Miwa T, Mukai Y, Takenaka S, Makino T, Fuji T. Potential risk of thermal damage to cervical nerve roots by a high-speed drill. J Bone Joint Surg Br 2009; 91 (11) 1541-1544
- 25 Takenaka S, Hosono N, Mukai Y, Miwa T, Fuji T. The use of cooled saline during bone drilling to reduce the incidence of upper-limb palsy after cervical laminoplasty: clinical article. J Neurosurg Spine 2013; 19 (4) 420-427
- 26 Chiba K, Toyama Y, Matsumoto M, Maruiwa H, Watanabe M, Hirabayashi K. Segmental motor paralysis after expansive open-door laminoplasty. Spine 2002; 27 (19) 2108-2115
- 27 Wada E, Yonenobu K, Suzuki S, Kanazawa A, Ochi T. Can intramedullary signal change on magnetic resonance imaging predict surgical outcome in cervical spondylotic myelopathy?. Spine 1999; 24 (5) 455-461 , discussion 462
- 28 Frykholm R. Lower cervical nerve roots and their investments. Acta Chir Scand 1951; 101 (6) 457-471
- 29 Yang CW, Fuh JL. C5 palsy after cervical spine decompression surgery. J Chin Med Assoc 2013; 76 (7) 363-364
- 30 Bose B, Sestokas AK, Schwartz DM. Neurophysiological detection of iatrogenic C-5 nerve deficit during anterior cervical spinal surgery. J Neurosurg Spine 2007; 6 (5) 381-385
- 31 Fan D, Schwartz DM, Vaccaro AR, Hilibrand AS, Albert TJ. Intraoperative neurophysiologic detection of iatrogenic C5 nerve root injury during laminectomy for cervical compression myelopathy. Spine 2002; 27 (22) 2499-2502
- 32 Inoue S, Tani T, Taniguchi S. The motor-evoked potentials elicited from the deltoid muscle by transcranial magnetic stimulation with a standardized facilitation: the potential diagnostic utility for C5 radiculopathy. Spine (Phila Pa 1976) 2003; 28 (3) 276-278