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Difficulty abducting the fingers against resistance
3%
43/1397
Decreased sensation in the medial forearm distribution
4%
57/1397
Inability to abduct the arm against gravity
84%
1167/1397
Decreased sensation in the middle finger
35/1397
Inability to extend the wrist against resistance
6%
79/1397
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Following decompression for cervical myelopathy, the C5 nerve root is most commonly affected. The exact cause of C5 nerve palsy (C5P) following cervical decompression in the setting of cervical myelopathy is unknown. It is hypothesized that spinal cord drift following decompression places tension on the C5 nerve root. C5P is commonly defined as a reduction of at least 1 in deltoid and/or biceps brachii manual muscle testing scores compared to preoperative scores, without any deterioration of myelopathic symptoms. There is a lower incidence of C5P in laminoplasty patients, but no difference between anterior cervical discectomy and fusion (ACDF) and posterior laminectomy and fusion patients. Risk factors include male gender and posterior laminectomy and fusion. The treatment of C5P is non-operative, as the vast majority of these patients will improve with time. Madhavan et al. performed a meta-analysis of 2868 patients looking at the outcomes of elderly patients with cervical myelopathy treated surgically. They compared patients greater than 75 years of age to younger patients, also commenting on strategies to minimize complications in these groups. They found no significant difference in the reported complications in these groups, including C5P, and suggest that surgery for elderly myelopathic patients should not be withheld simply on the basis of age. Shou et al. similarly performed a meta-analysis looking at the prevalence of C5P after cervical decompressive surgery. They found the overall risk of C5P in the 13,621 patients included in their study was 5.3%. They found male gender and posterior laminectomy and fusion to be associated with a higher risk of C5P development. Nassr et al. retrospectively reviewed 750 cases of multilevel cervical decompressions performed by a single surgeon looking at the incidence of C5P. The incidence of C5P was 6.7%. They found no difference in C5P development in patients undergoing multilevel cervical corpectomy, corpectomy with posterior fusion, posterior laminectomy and fusion, and laminoplasty; there was a trend toward increased C5P development in posterior laminectomy and fusion patients. Incorrect Answers: Answer 1: This describes a T1 nerve palsy. Answer 2: This describes a T1 nerve palsy. Answer 4: This describes a C7 nerve palsy. Answer 5: This describes a C6 nerve palsy.
4.0
(6)
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