Incidence and Prognostic Factors of C5 Palsy: A Clinical Study of 1001 Cases and Review of the Literature

• Published in: Neurosurgery Vol. 74; no. 6; pp. 595 - 605
• Main Authors: Bydon, Mohamad, Macki, Mohamed, Kaloostian, Paul, Sciubba, Daniel M, Wolinsky, Jean-Paul, Gokaslan, Ziya L, Belzberg, Allan J, Bydon, Ali, Witham, Timothy F
• Format: Journal Article
• Language: English
• Published: United States Copyright by the Congress of Neurological Surgeons 01.06.2014; Wolters Kluwer Health, Inc
• Subjects: Adult; Age Factors; Aged; Aged, 80 and over; Decompression, Surgical - adverse effects; Decompression, Surgical - methods; Female; Humans; Incidence; Laminectomy - adverse effects; Male; Medical prognosis; Middle Aged; Neurosurgery; Paralysis - epidemiology; Paralysis - surgery; Postoperative Complications - epidemiology; Prognosis; Retrospective Studies; Review Literature as Topic; Spinal Fusion - adverse effects; Spinal Nerve Roots - surgery
• ISSN: 0148-396X; 1524-4040
• DOI: 10.1227/NEU.0000000000000322

BACKGROUND:C5 palsy is a known cause of postoperative deltoid weakness. Prognostic variables affecting the incidence of the palsy have been poorly understood. OBJECTIVE:To determine the incidence and perioperative characteristics/predictors of C5 palsy after anterior vs posterior operations. METHODS:All patients undergoing C4-5 operations for degenerative conditions were retrospectively reviewed over 21 years. Anterior operations included an anterior cervical discectomy and fusion (ACDF) or a corpectomy, whereas posterior operations included laminectomy and fusion (± foraminotomies). RESULTS:Of the total 1001 operations, in 49.0% anterior and 51.0% posterior cases, there was an overall C5 palsy incidence of 5.2% (52 cases)1.6% and 8.6%, respectively (P < .001). Of the 99 corpectomies, the palsy incidence of 4.0% was not only higher than ACDFs (1.0%), but also followed an upward trend with increasing corpectomy levels (P = .009). Of the 69 posterior and 83 anterior C4-5 foraminotomies, the incidence of C5 palsy was statistically higher in the posterior (14.5%) vs anterior (2.4%) cohort (P = .01). Multiple logistical regression identified older age as the strongest predictor of C5 palsy in the anterior (P = .02) and C4-5 foraminotomy in the posterior (P = .06) cohort. This condition improved within 3 to 6 months in 75% of patients in the anterior and 88.6% in the posterior cohort after a mean follow-up of 14.4 and 27.6 months, respectively. CONCLUSION:In one of the largest cohorts on C5 palsy, we found in anterior operations an increasing number of corpectomy levels had a higher incidence of C5 palsy; however, older age was the strongest predictor of C5 palsy. In posterior operations, C4-5 foraminotomy carried the strongest correlation. ABBREVIATIONS:ACDF, anterior cervical discectomy and fusionOPLL, ossification of the posterior longitudinal ligament