The incidence of C5 palsy after multilevel cervical decompression procedures: a review of 750 consecutive cases
Authors
Nassr, AhmadEck, Jason C.
Ponnappan, Ravi K.
Zanoun, Rami R.
Donaldson, William F. III
Kang, James D.
UMass Chan Affiliations
Department of Orthopedics and Physical RehabilitationDocument Type
Journal ArticlePublication Date
2012-02-01Keywords
AdultAged
Aged, 80 and over
Brachial Plexus
Brachial Plexus Neuropathies
Cervical Vertebrae
Decompression, Surgical
Female
Humans
Incidence
Intraoperative Complications
Male
Middle Aged
Retrospective Studies
Spinal Nerve Roots
Young Adult
Orthopedics
Rehabilitation and Therapy
Metadata
Show full item recordAbstract
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.Source
Spine (Phila Pa 1976). 2012 Feb 1;37(3):174-8. doi: 10.1097/BRS.0b013e318219cfe9. Link to article on publisher's siteDOI
10.1097/BRS.0b013e318219cfe9Permanent Link to this Item
http://hdl.handle.net/20.500.14038/42939PubMed ID
22293780Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1097/BRS.0b013e318219cfe9