Time to recovery predicted by the severity of postoperative C5 palsy

Restricted access

OBJECTIVE

Postoperative C5 palsy affects 7%–12% of patients who undergo posterior cervical decompression for degenerative cervical spine pathologies. Minimal evidence exists regarding the natural history of expected recovery and variables that affect palsy recovery. The authors investigated pre- and postoperative variables that predict recovery and recovery time among patients with postoperative C5 palsy.

METHODS

The authors included patients who underwent posterior cervical decompression at a tertiary referral center between 2004 and 2018 and who experienced postoperative C5 palsy. All patients had preoperative MR images and full records, including operative note, postoperative course, and clinical presentation. Kaplan-Meier survival analysis was used to evaluate both times to complete recovery and to new neurological baseline—defined by deltoid strength on manual motor testing of the affected side—as a function of clinical symptoms, surgical maneuvers, and the severity of postoperative deficits.

RESULTS

Seventy-seven patients were included, with an average age of 64 years. The mean follow-up period was 17.7 months. The mean postoperative C5 strength was grade 2.7/5, and the mean time to first motor examination with documented C5 palsy was 3.5 days. Sixteen patients (21%) had bilateral deficits, and 9 (12%) had new-onset biceps weakness; 36% of patients had undergone C4–5 foraminotomy of the affected root, and 17% had presented with radicular pain in the dermatome of the affected root. On univariable analysis, patients’ reporting of numbness or tingling (p = 0.02) and a baseline deficit (p < 0.001) were the only predictors of time to recovery. Patients with grade 4+/5 weakness had significantly shorter times to recovery than patients with grade 4/5 weakness (p = 0.001) or ≤ grade 3/5 weakness (p < 0.001). There was no difference between those with grade 4/5 weakness and those with ≤ grade 3/5 weakness. Patients with postoperative strength < grade 3/5 had a < 50% chance of achieving complete recovery.

CONCLUSIONS

The timing and odds of recovery following C5 palsy were best predicted by the magnitude of the postoperative deficit. The use of C4–5 foraminotomy did not predict the time to or likelihood of recovery.

ABBREVIATIONS AP = anteroposterior; MMT = manual motor testing; PVF = posterior vertebral face.
Article Information

Contributor Notes

Correspondence Daniel M. Sciubba: Johns Hopkins School of Medicine, Baltimore, MD. dsciubb1@jhmi.edu.INCLUDE WHEN CITING Published online October 25, 2019; DOI: 10.3171/2019.8.SPINE19602.Disclosures Matthew L. Goodwin: consultant for ROM3 and Augmedics. Sheng-Fu Lo: grants from AO Foundation and Chordoma Foundation. Timothy F. Witham: grants from Eli Lilly and Co. and the Gordon and Marilyn Macklin Foundation. Nicholas Theodore: royalties from and ownership interest in Globus Medical; consultant for Globus Medical and DePuy Synthes. Daniel M. Sciubba: consultant for Baxter, DePuy Synthes, Globus Medical, K2M, Medtronic, NuVasive, and Stryker.
Headings
References
  • 1

    Blizzard DJGallizzi MASheets CKlement MRKleeman LTCaputo AM: The role of iatrogenic foraminal stenosis from lordotic correction in the development of C5 palsy after posterior laminectomy and fusion. J Orthop Surg Res 10:1602015

    • Search Google Scholar
    • Export Citation
  • 2

    Boniello APetrucelli PKerbel YHorn SBortz CABrown AE: Short-term outcomes following cervical laminoplasty and decompression and fusion with instrumentation. Spine (Phila Pa 1967) 44:E1018E10232019

    • Search Google Scholar
    • Export Citation
  • 3

    Bydon MMacki MAygun NSciubba DMWolinsky JPWitham TF: Development of postoperative C5 palsy is associated with wider posterior decompressions: an analysis of 41 patients. Spine J 14:286128672014

    • Search Google Scholar
    • Export Citation
  • 4

    Chiba KToyama YMatsumoto MMaruiwa HWatanabe MHirabayashi K: Segmental motor paralysis after expansive open-door laminoplasty. Spine (Phila Pa 1967) 27:210821152002

    • Search Google Scholar
    • Export Citation
  • 5

    Fan DSchwartz DMVaccaro ARHilibrand ASAlbert TJ: Intraoperative neurophysiologic detection of iatrogenic C5 nerve root injury during laminectomy for cervical compression myelopathy. Spine (Phila Pa 1967) 27:249925022002

    • Search Google Scholar
    • Export Citation
  • 6

    Hashimoto MMochizuki MAiba AOkawa AHayashi KSakuma T: C5 palsy following anterior decompression and spinal fusion for cervical degenerative diseases. Eur Spine J 19:170217102010

    • Search Google Scholar
    • Export Citation
  • 7

    Ikegami STsutsumimoto TOhta HYui MKosaku HUehara M: Preoperative spinal cord damage affects the characteristics and prognosis of segmental motor paralysis after cervical decompression surgery. Spine (Phila Pa 1967) 39:4634682014

    • Search Google Scholar
    • Export Citation
  • 8

    Imagama SMatsuyama YYukawa YKawakami NKamiya MKanemura T: C5 palsy after cervical laminoplasty: a multicentre study. J Bone Joint Surg Br 92:3934002010

    • Search Google Scholar
    • Export Citation
  • 9

    Kaplan ELMeier P: Nonparametric estimation from incomplete observations. J Am Stat Assoc 53:4574811958

  • 10

    Katsumi KYamazaki AWatanabe KOhashi MShoji H: Can prophylactic bilateral C4/C5 foraminotomy prevent postoperative C5 palsy after open-door laminoplasty?: a prospective study. Spine (Phila Pa 1967) 37:7487542012

    • Search Google Scholar
    • Export Citation
  • 11

    Lim CHRoh SWRhim SCJeon SR: Clinical analysis of C5 palsy after cervical decompression surgery: relationship between recovery duration and clinical and radiological factors. Eur Spine J 26:110111102017

    • Search Google Scholar
    • Export Citation
  • 12

    Liu CYZygourakis CCYoon SKliot TMoriates CRatliff J: Trends in utilization and cost of cervical spine surgery using the National Inpatient Sample Database, 2001 to 2013. Spine (Phila Pa 1967) 42:E906E9132017

    • Search Google Scholar
    • Export Citation
  • 13

    Macki MAlam RKerezoudis PGokaslan ZBydon ABydon M: Manual muscle test at C5 palsy onset predicts the likelihood of and time to C5 palsy resolution. J Clin Neurosci 24:1121162016

    • Search Google Scholar
    • Export Citation
  • 14

    Miller JALubelski DAlvin MDBenzel ECMroz TE: C5 palsy after posterior cervical decompression and fusion: cost and quality-of-life implications. Spine J 14:285428602014

    • Search Google Scholar
    • Export Citation
  • 15

    Nakashima HImagama SYukawa YKanemura TKamiya MYanase M: Multivariate analysis of C-5 palsy incidence after cervical posterior fusion with instrumentation. J Neurosurg Spine 17:1031102012

    • Search Google Scholar
    • Export Citation
  • 16

    Nassr AEck JCPonnappan RKZanoun RRDonaldson WF IIIKang JD: The incidence of C5 palsy after multilevel cervical decompression procedures: a review of 750 consecutive cases. Spine (Phila Pa 1967) 37:1741782012

    • Search Google Scholar
    • Export Citation
  • 17

    Okamoto TNeo MFujibayashi SIto HTakemoto MNakamura T: Mechanical implant failure in posterior cervical spine fusion. Eur Spine J 21:3283342012

    • Search Google Scholar
    • Export Citation
  • 18

    Pan FMWang SJMa BWu DS: C5 nerve root palsy after posterior cervical spine surgery: a review of the literature. J Orthop Surg (Hong Kong) 25:2309499016684502017

    • Search Google Scholar
    • Export Citation
  • 19

    Pennington ZLubelski DD’Sa AWestbroek EAhmed AKGoodwin ML: Preoperative clinical and radiographic variables predict postoperative C5 palsy. World Neurosurg 127:e585e5922019

    • Search Google Scholar
    • Export Citation
  • 20

    Sakaura HHosono NMukai YIshii TYoshikawa H: C5 palsy after decompression surgery for cervical myelopathy: review of the literature. Spine (Phila Pa 1967) 28:244724512003

    • Search Google Scholar
    • Export Citation
  • 21

    Sasai KSaito TAkagi SKato IOhnari HIida H: Preventing C5 palsy after laminoplasty. Spine (Phila Pa 1967) 28:197219772003

  • 22

    Sciubba DMChaichana KLWoodworth GFMcGirt MJGokaslan ZLJallo GI: Factors associated with cervical instability requiring fusion after cervical laminectomy for intradural tumor resection. J Neurosurg Spine 8:4134192008

    • Search Google Scholar
    • Export Citation
  • 23

    Thompson SESmith ZAHsu WKNassr AMroz TEFish DE: C5 palsy after cervical spine surgery: a multicenter retrospective review of 59 cases. Global Spine J 7 (1 Suppl):64S70S2017

    • Search Google Scholar
    • Export Citation
  • 24

    Yoshihara HMargalit AYoneoka D: Incidence of C5 palsy: meta-analysis and potential etiology. World Neurosurg 122:e828e8372019

TrendMD
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 485 485 134
Full Text Views 76 76 20
PDF Downloads 51 51 17
EPUB Downloads 0 0 0
PubMed
Google Scholar