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Clinical and Radiographic Analysis of C5 Palsy After Anterior Cervical Decompression and Fusion for Cervical Degenerative Disease

Kim, Sungjin MD; Lee, Sun-Ho MD; Kim, Eun-Sang MD, PhD; Eoh, Whan MD, PhD

Journal of Spinal Disorders and Techniques: December 2014 - Volume 27 - Issue 8 - p 436–441
doi: 10.1097/BSD.0b013e31826a10b0

Study Design: A retrospective cohort study.

Objective: To present the cases of 6 patients who developed C5 palsy after anterior decompression and discuss the mechanism of C5 palsy development, especially with respect to radiographic change.

Summary of Background Data: C5 palsy has been reported to be a major complication of both anterior and posterior decompression procedures. Although several mechanisms of injury have been proposed, few reports have been issued on C5 palsy after anterior decompression surgery.

Methods: A retrospective medical record review was performed on 134 patients who underwent anterior decompression and fusion in our hospital from 2008 to 2011. C5 paralysis was defined as deterioration in muscle power of the deltoid or biceps brachii by at least 1 grade by manual muscle testing. Clinical features and radiologic parameters were evaluated to identify predisposing factors.

Results: Six patients (4.3%) suffered postoperative paralysis in the upper extremities (C5 radiculopathy). C5 palsy did not occur in 30 patients with radiculopathy. Excluding patients with cervical radiculopathy, the rate of C5 palsies was 5.8% for myelopathy patients. Three of 76 (3.95‘%) cervical spondylotic myelopathy cases, one of 6 (16.7%) cervical spondylotic radiculomyelopathy patients, and 2 of 22 (9%) patients with ossification of the posterior longitudinal ligament showed C5 palsy. In 2 of the 6, C5 palsy developed after anterior cervical corpectomy, in 3 patients after anterior cervical discectomy and plate fusion, and in 1 after a standalone cage. Two patients underwent reoperation for foraminal decompression. Of the 4 treated conservatively, 3 fully recovered and the other almost fully improved (grade 4). Of 2 patients treated surgically, 1 showed full improvements. The other had no improvement. Radiographic measurements of these 6 patients showed that lordosis at operated segments increased postoperatively (mean, 6 degrees), and that overall sagittal alignments of the cervical spine (C3–C7) also increased (mean, 8.2 degrees).

Conclusions: This study suggests that improved lordosis of the cervical spinal column can result in traction injury to the spinal cord and C5 nerve roots and that reoperation does not always produce good results. Methods of preventing and treating C5 palsy after anterior decompression and fusion require more evaluation.

Department of Neurosurgery, School of Medicine, Samsung Medical Center, Sungkyunkwan University, Gangnam-gu, Seoul, South Korea

The authors declare no conflict of interest.

Reprints: Sun-Ho Lee, MD, Department of Neurosurgery, School of Medicine, Samsung Medical Center, Sungkyunkwan University, 50 Ilwon-dong, Gangnam-gu, Seoul 135-710, South Korea (e-mail:

Received November 13, 2011

Accepted May 10, 2012

© 2014 by Lippincott Williams & Wilkins, Inc.