Review Question - QID 211520

The patient is presenting with a post-operative C5 nerve palsy after a cervical spine procedure. Studies have found no significant differences in C5 palsy rates following anterior or posterior based spine procedures.

Post-operative C5 palsy is a relatively common complication following cervical spine surgery with an approximate incidence of 5% reported. Patients typically present with painless deltoid and biceps weakness either immediately following surgery or several weeks post-op. Increased rates have been reported in male patients and patients undergoing cervical laminectomy and fusion. The pathophysiology is not clear at this time but is speculated to be the result of dorsal migration of the spinal cord following decompression leading to C5 nerve root traction. Treatment involves observation as recovery is frequently spontaneous by 1-year post-op.

Shou et al. performed a meta-analysis of 79 studies that included 704 cases of postoperative C5 palsy in 13,621 patients undergoing cervical spine surgery. The authors reported an overall incidence of 5.3%, no difference in rates between anterior or posterior surgery, the highest rate of 11% following laminectomy and fusion, and the lowest rate of 3.3% following an anterior cervical discectomy and fusion. They also reported a statistically significant increased rate of 5.2% males compared to 2.2% in females. The authors concluded that cervical spine surgery is associated with a high risk of C5-palsy with the highest observed in laminectomy and fusion procedures and male patients.

Madhavan et al. performed a meta-analysis of 18 studies consisting of 1169 elderly patients and 1699 non-elderly patients that received surgical treatment for cervical spondylotic myelopathy. The authors reported from the pooled meta-analysis that elderly patients had a greater increase in the Japanese Orthopedic Association (JOA) scores, smaller postoperative Cobb angles, and a greater increase in spinal canal diameter compared to the non-elderly cohort. They further reported an insignificant difference in complication rates. The authors concluded that despite previous literature describing increased age as an independent risk factor for poor outcomes in spine surgery, elderly patients have the potential to greatly benefit from decompressive surgery for cervical myelopathy.

Nassr et al. performed a retrospective study of 630 consecutive patients undergoing multilevel cervical spine decompression to determine the incidence of postoperative C5 palsy. The authors reported an overall incidence of 6.7%, with the highest incidence of 9.5% following laminectomy and fusion. Although there were no statistical differences in C5-palsy rates between different surgical techniques, males had a significantly higher rate of 8.6% compared to 4.5% in females. The authors concluded that their reported incidence rate is consistent with previous studies with no difference found between surgical techniques.

Incorrect Answers:
Answer 1: Most patients make a near-full recovery by 1-year post-op.
Answer 2: Studies have not found there to be a significant difference in C5 palsy rates with ossification of the posterior longitudinal ligament.
Answer 3: Studies have demonstrated that males have a significantly higher risk of developing postoperative C5 palsy.
Answer 5: Laminoplasty has not been found to be an independent risk factor for C5 nerve palsy.