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C5 Motor Palsy After Single- and Multi-level Anterior Cervical Diskectomy and Fusion

A Retrospective Review

Wagner, Scott C., MD; Sebastian, Arjun S., MD; Butler, Joseph S., MD; Kaye, Ian D., MD; Morrissey, Patrick B., MD; Hilibrand, Alan S., MD, MBA; Vaccaro, Alexander R., MD, PhD, MBA; Kepler, Christopher K., MD, MBA

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: April 15, 2019 - Volume 27 - Issue 8 - p e390–e394
doi: 10.5435/JAAOS-D-17-00764
Research Article

Introduction: Postoperative C5 nerve root palsy is a known complication after cervical surgery. The effect of increasing number of levels fused on the prevalence of C5 palsy after anterior cervical diskectomy and fusion (ACDF) is unclear.

Methods: Medical records of ACDF patients that included the C4-5 level at one institution were retrospectively reviewed. C5 palsy was defined as motor decline of the deltoid and/or biceps brachii muscle function by at least 1 level on standard manual muscle testing.

Results: A total of 196 patients met the inclusion criteria, with no significant differences noted between groups undergoing single- or multi-level ACDF. The overall C5 palsy rate was 5.1%. Palsy rates were not statistically significant based on the number of levels fused. Six of the 10 patients with C5 palsy had complete recovery of motor strength, whereas 2 patients had at least some level of strength recovery.

Conclusion: The overall C5 palsy rate was 5.1% for all patients undergoing up to four-level ACDF. The rate of postoperative motor decline was lowest in the patients undergoing two-level ACDF and highest in the single-level group, but this finding did not reach statistical significance. The prognosis for strength recovery by final follow-up is excellent.

Level of Evidence: Level III, Case-control

From the Department of Orthopaedic Surgery, Rothman Instititute at Thomas Jefferson University, Philadelphia, PA.

Correspondence to Dr. Wagner:

Dr. Hilibrand or an immediate family member has received royalties from Amedica and Zimmer Biomet; has stock or stock options held in Life Spine and Paradigm Spine; and serves as a board member, owner, officer, or committee member of the American Academy of Orthopaedic Surgeons. Dr. Vaccaro or an immediate family member has received royalties from Aesculap, Atlas Spine, Globus Medical, Medtronic, SpineWave, and Stryker; serves as a paid consultant to Atlas Spine; DePuy, Gerson Lehrman Group, Globus Medical, Guidepoint Global, Innovative Surgical Design, Medtronic, NuVasive, Orthobullets, SpineWave, Stout Medical, and Stryker; and has stock or stock options held in Advanced Spinal Intellectual Properties, Avaz Surgical, Bonovo Orthopaedics, Computational Biodynamics, Cytonics, Dimension Orthotics LLC, Electrocore, Flagship Surgical, FlowPharma, Franklin Bioscience, Gamma Spine, Globus Medical, Innovative Surgical Design, Insight Therapeutics, NuVasive, Paradigm Spine, Parvizi Surgical Innovations, Prime Surgeons, Progressive Spinal Technologies, Replication Medica, Spine Medica, Spinology, Stout Medical, and Vertiflex. Dr. Kepler or an immediate family member has received research or institutional support from Zimmer Biomet, Medtronic, Pfizer, and Regeneration Technologies. None of the following authors nor any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Wagner, Dr. Sebastian, Dr. Butler, Dr. Kaye, and Dr. Morrissey.

Institutional Review Board approval was obtained for this study. Two authors (ie, Dr. Wagner and Dr. Morrissey) are employees of the US Government, and this work was prepared as part of their official duties, and as such, there is no copyright to be transferred on their behalf. The views expressed in this article are those of the authors and do not reflect the official policies of the Departments of Army/Navy/Air Force, Department of Defense, or US Government.

© 2019 by American Academy of Orthopaedic Surgeons
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