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

Bydon, Mohamad MD*,‡,§; Macki, Mohamed BS*,‡,§; Kaloostian, Paul MD; Sciubba, Daniel M. MD; Wolinsky, Jean-Paul MD; Gokaslan, Ziya L. MD‡,§; Belzberg, Allan J. MD; Bydon, Ali MD‡,§; Witham, Timothy F. MD

doi: 10.1227/NEU.0000000000000322
Research-Human-Clinical Studies

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 fusion

OPLL, ossification of the posterior longitudinal ligament

Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland;

§Johns Hopkins Spinal Biomechanics and Surgical Outcomes Laboratory, Baltimore, Maryland

Correspondence: Timothy F. Witham, MD, The Johns Hopkins Hospital, Department of Neurosurgery, Meyer 7-109, 600 N. Wolfe Street, Baltimore, MD 21287. E-mail:

* These authors contributed equally to this manuscript.

Received October 17, 2013

Accepted February 05, 2014

Copyright © by the Congress of Neurological Surgeons