C5 Palsy in Cervical Decompression Surgeries: A Study in 390 Patients

Abstract

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.

Keywords

C5 palsy - cervical decompression - myelopathy

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