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The Incidence of C5 Palsy After Multilevel Cervical Decompression Procedures: A Review of 750 Consecutive Cases

Nassr, Ahmad MD*; Eck, Jason C. DO, MS; Ponnappan, Ravi K. MD; Zanoun, Rami R. BS§; Donaldson, William F. III MD§; Kang, James D. MD§

doi: 10.1097/BRS.0b013e318219cfe9
Cervical Spine
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Study Design. Retrospective review of 750 consecutive multilevel cervical spine decompression surgeries performed by a single spine surgeon.

Objective. To determine the incidence of C5 palsy in a large consecutive series of multilevel cervical spine decompression procedures.

Summary of Background Data. Palsy of the C5 nerve is a well-known potential complication of cervical spine surgery with reported rates ranging from 0% to 30%. The etiology remains uncertain but has been attributed to iatrogenic injury during surgery, tethering from shifting of the spinal cord, spinal cord ischemia, and reperfusion injury of the spinal cord.

Methods. We included patients undergoing multilevel cervical corpectomy, corpectomy with posterior fusion, posterior laminectomy and fusion, and laminoplasty. Exclusion criteria included lack of follow-up data, spinal cord injury preventing preoperative or postoperative motor testing, or surgery not involving the C5 level. Incidence of C5 palsy was determined and compared to determine whether significant differences existed among the various procedures, patient age, sex, revision surgery, preoperative weakness, diabetes, smoking, number of levels decompressed, and history of previous upper extremity surgery.

Results. Of the 750 patients, 120 were eliminated on the basis of the exclusion criteria. The 630 patients included in the analysis consisted of 292 females and 338 males. The mean age was 58 years (range, 19–87). The incidence of C5 nerve palsy for the entire group was 42 of 630 (6.7%). The incidence was highest for the laminectomy and fusion group (9.5%), followed by the corpectomy with posterior fusion group (8.4%), the corpectomy group (5.1%), and finally the laminoplasty group (4.8%), although these differences did not reach statistical significance. There was a significantly higher incidence in males (8.6% vs. 4.5%, P = 0.05).

Conclusion. Incidence of C5 nerve palsy after cervical spine decompression was 6.7%. This is consistent with previously published studies and represents the largest series of North American patients to date. There is no statistically significant difference in incidence of C5 palsy based on surgical procedure, although there was a trend toward higher rates with laminectomy and fusion.

A retrospective review of 750 consecutive multilevel decompression procedures of the cervical spine was performed. The overall incidence of C5 nerve palsy was 6.7%. There is no statistically significant difference in incidence of C5 palsy based on surgical procedure, although there was a trend toward high rates with laminectomy and fusion.

*Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN

Department of Orthopedics and Physical Rehabilitation, UMass Memorial Medical Center, Worcester, MA

Department of Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA

§Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA.

Address correspondence and reprint requests to Ahmad Nassr, MD, Mayo Clinic, 200 First Street SW, Rochester, MN 55906; E-mail: nassr.ahmad@mayo.edu

Acknowledgment date: November 9, 2010. First revision date: January 9, 2011. Acceptance date: March 7, 2011.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

© 2012 Lippincott Williams & Wilkins, Inc.