C5 Nerve root palsies following cervical spine surgery: A review

Nancy E Epstein, Renee Hollingsworth, Nancy E Epstein, Renee Hollingsworth

Abstract

Background: Cervical C5 nerve root palsies may occur in between 0% and 30% of routine anterior or posterior cervical spine operations. They are largely attributed to traction injuries/increased cord migration following anterior/posterior decompressions. Of interest, almost all studies cite spontaneous resolution of these deficits without surgery with 3-24 postoperative months.

Methods: Different studies cite various frequencies for C5 root palsies following anterior or posterior cervical spine surgery. In their combined anterior/posterior series involving C4-C5 level decompressions, Libelski et al. cited up to a 12% incidence of C5 palsies. In Gu et al. series, C5 root palsies occurred in 3.1% of double-door laminoplasty, 4.5% of open-door laminoplasty, and 11.3% of laminectomy. Miller et al. observed an intermediate 6.9% frequency of C5 palsies followed by posterior cervical decompressions and fusions (PCDF).

Results: Gu et al. also identified multiple risk factors for developing C5 palsies following posterior surgery; male gender, ossification of the posterior longitudinal ligament (OPLL), narrower foramina, laminectomy, and marked dorsal spinal cord drift. Miller et al. also identified an average $1918 increased cost for physical/occupational therapy for patients with C5 palsies.

Conclusions: The incidence of C5 root deficits for anterior/posterior cervical surgery at C4-C5 was 12% in one series, and ranged up to 11.3% for laminectomies, while others cited 0-30%. Although identification of preoperative risk factors for C5 root deficits may help educate patients regarding these risks, there is no clear method for their avoidance at this time.

Keywords: Anterior surgery; C4-C5 surgery; C5 root palsies; cervical; factors; posterior surgery; risk.

References

    1. Chang PY, Chan RC, Tsai YA, Huang WC, Cheng H, Wang JC, et al. Quantitative measures of functional outcomes and quality of life in patients with C5 palsy. J Chin Med Assoc. 2013;76:378–84.
    1. Chen Y, Chen D, Wang X, Yang H, Liu X, Miao J, et al. Significance of segmental instability in cervical ossification of the posterior longitudinal ligament and treated by a posterior hybrid technique. Arch Orthop Trauma Surg. 2013;133:171–7.
    1. Currier BL. Neurological complications of cervical spine surgery: C5 palsy and intraoperative monitoring. Spine (Phila Pa 1976) 2012;37:E328–34.
    1. Du W, Zhang P, Shen Y, Zhang YZ, Ding WY, Ren LX. Enlarged laminectomy and lateral mass screw fixation for multilevel cervical degenerative myelopathy associated with kyphosis. Spine J. 2014;14:57–64.
    1. Eskander MS, Balsis SM, Balinger C, Howard CM, Lewing NW, Eskander JP, et al. The association between preoperative spinal cord rotation and postoperative C5 nerve palsy. J Bone Joint Surg Am. 2012;94:1605–9.
    1. Gu Y, Cao P, Gao R, Tian Y, Liang L, Wang C, et al. Incidence and risk factors of C5 palsy following posterior cervical decompression: A systematic review. PLoS One. 2014;9:e101933.
    1. Guzman JZ, Baird EO, Fields AC, McAnany SJ, Qureshi SA, Hecht 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:950–5.
    1. Kanchiku T, Imajo Y, Suzuki H, Yoshida Y, Nishida N, Taguchi T. Results of surgical treatment of cervical spondylotic myelopathy in patients aged 75 years or more: A comparative study of operative methods. Arch Orthop Trauma Surg. 2014;134:1045–50.
    1. Kim S, Lee SH, Kim ES, Eoh W. Clinical and radiographic analysis of c5 palsy after anterior cervical decompression and fusion for cervical degenerative disease. J Spinal Disord Tech. 2014;27:436–41.
    1. Lawrence BD, Jacobs WB, Norvell DC, Hermsmeyer JT, Chapman JR, Brodke DS. Anterior versus posterior approach for treatment of cervical spondylotic myelopathy: A systematic review. Spine (Phila Pa 1976) 2013;38(22 Suppl 1):S173–82.
    1. Liu Y, Qi M, Chen H, Yang L, Wang X, Shi G, et al. Comparative analysis of complications of different reconstructive techniques following anterior decompression for multilevel cervical spondylotic myelopathy. Eur Spine J. 2012;21:2428–35.
    1. Liu K, Shi J, Jia L, Yuan W. Surgical technique: Hemilaminectomy and unilateral lateral mass fixation for cervical ossification of the posterior longitudinal ligament. Clin Orthop Relat Res. 2013;471:2219–24.
    1. Lubelski D, Derakhshan A, Nowacki AS, Wang JC, Steinmetz MP, Benzel EC, et al. Predicting C5 palsy via the use of preoperative anatomic measurements. Spine J. 2014;14:1895–901.
    1. 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;14:2854–60.
    1. Nakamae T, Tanaka N, Nakanishi K, Kamei N, Izumi B, Fujioka Y, et al. Investigation of segmental motor paralysis after cervical laminoplasty using intraoperative spinal cord monitoring with transcranial electric motor-evoked potentials. J Spinal Disord Tech. 2012;25:92–8.
    1. Nakashima H, Imagama S, Yukawa Y, Kanemura T, Kamiya M, Yanase M, et al. Multivariate analysis of C-5 palsy incidence after cervical posterior fusion with instrumentation. J Neurosurg Spine. 2012;17:103–10.
    1. Nassr A, Eck JC, Ponnappan RK, Zanoun RR, Donaldson WF, 3rd, Kang JD. The incidence of C5 palsy after multilevel cervical decompression procedures: A review of 750 consecutive cases. Spine (Phila Pa 1976) 2012;37:174–8.
    1. Odate S, Shikata J, Yamamura S, Soeda T. Extremely wide and asymmetric anterior decompression causes postoperative C5 palsy: An analysis of 32 patients with postoperative C5 palsy after anterior cervical decompression and fusion. Spine (Phila Pa 1976) 2013;38:2184–9.
    1. Odate S, Shikata J, Kimura H, Soeda T. Hybrid decompression and fixation technique versus plated three-vertebra corpectomy for four-segment cervical myelopathy: Analysis of 81 cases with a minimum 2-year follow-up. J Spinal Disord Tech. 2013 Nov 8; [Epub ahead of print]
    1. Ohashi M, Yamazaki A, Watanabe K, Katsumi K, Shoji H. Two-year clinical and radiological outcomes of open-door cervical laminoplasty with prophylactic bilateral C4-C5 foraminotomy in a prospective study. Spine (Phila Pa 1976) 2014;39:721–7.
    1. Qian L, Shao J, Liu Z, Cheng L, Zeng Z, Jia Y, et al. Comparison of the safety and efficacy of anterior ‘skip’ corpectomy versus posterior decompression in the treatment of cervical spondylotic myelopathy. J Orthop Surg Res. 2014;9:63.
    1. Radcliff KE, Limthongkul W, Kepler CK, Sidhu GD, Anderson DG, Rihn JA, et al. Cervical laminectomy width and spinal cord drift are risk factors for postoperative C5 palsy. J Spinal Disord Tech. 2014;27:86–92.
    1. Shamji MF, Massicotte EM, Traynelis VC, Norvell DC, Hermsmeyer JT, Fehlings MG. Comparison of anterior surgical options for the treatment of multilevel cervical spondylotic myelopathy: A systematic review. Spine (Phila Pa 1976) 2013;38(22 Suppl 1):S195–209.
    1. Wang L, Wang Y, Yu B, Li Z, Liu X. Open-door versus French-door laminoplasty for the treatment of cervical multilevel compressive myelopathy. J Clin Neurosci. 2015;22:450–5.
    1. Wu FL, Sun Y, Pan SF, Zhang L, Liu ZJ. Risk factors associated with upper extremity palsy after expansive open-door laminoplasty for cervical myelopathy. Spine J. 2014;14:909–15.
    1. Yang L, Gu Y, Shi J, Gao R, Liu Y, Li J, et al. Modified plate-only open-door laminoplasty versus laminectomy and fusion for the treatment of cervical stenotic myelopathy. Orthopedics. 2013;36:e79–87.

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