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Does Resection of the Posterior Longitudinal Ligament Impact the Incidence of C5 Palsy After Cervical Corpectomy Procedures?

A Review of 459 Consecutive Cases

Nassr, Ahmad, MD; Aleem, Ilyas S., MD, MSc, FRCSC; Eck, Jason C., DO, MS; Woods, Barrett, MD§; Ponnappan, Ravi K., MD; Donaldson, William F. III, MD||; Kang, James D., MD∗∗

doi: 10.1097/BRS.0000000000001806

Study Design. Retrospective review.

Objective. To evaluate key risk factors for the development of C5 palsy after cervical corpectomy, including resection of the posterior longitudinal ligament (PLL).

Summary of Background Data. Postoperative C5 palsy is a well-known complication after cervical spine surgery. It is unknown whether resection of the PLL affects the incidence of C5 palsy.

Methods. We performed a retrospective review of 459 consecutive patients undergoing anterior cervical corpectomies over a 15-year period. Medical records were reviewed to gather demographic data, operative details, and the incidence of C5 palsy. We performed regression analyses to identify variables that predicted the development of C5 palsy.

Results. Our final analysis included 397 patients (females 51.4%, mean age 55.6 ± 11.6 yrs). Anterior corpectomy alone was performed in 255 (64.2%) patients, and combined anterior and posterior fusion was performed in 142 (35.8%) patients. Twenty-four patients (6.0%) developed C5 nerve palsy. Univariable regression demonstrated age greater than 65 (odds ratio, OR 2.7, 95% confidence interval, CI 1.2 to 6.3), corpectomy of three or more levels (OR 6.3, 95% CI 2.1 to 18.9), presence of ossification of the PLL (OR 4.3, 95% CI 1.6 to 11.7), and complete or partial resection of the PLL (OR 2.6, 95% CI 1.0 to 6.7) predicted development of C5 palsy. Multivariable regression demonstrated that the odds of getting C5 palsy with complete or partial resection of the PLL is 4.0 times (95% CI 1.5 to 10.5) higher compared with patients with an intact PLL. There were no significant differences in C5 palsy rates based on surgical approach (anterior vs. anterior plus posterior), sex, smoking status, or diabetes.

Conclusion. Age greater than 65 years, corpectomy of three or more levels, presence of ossification of the PLL, and complete or partial resection of the PLL significantly predicted the development of C5 palsy.

Level of Evidence: 4

Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN

Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI

Center for Sports Medicine and Orthopedics, Chattanooga, TN

§Rothman Institute, Thomas Jerfferson University, Philadelphia, PA

Jersey Spine Associates, Somers Point, NJ

||Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, PA

∗∗Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA.

Address correspondence and reprint requests to Ahmad Nassr, MD, Department of Orthopedic Surgery, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905; E-mail:

Received 27 April, 2016

Revised 17 June, 2016

Accepted 5 July, 2016

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

No funds were received in support of this work.

Relevant financial activities outside the submitted work: payment for lecture, grants.

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