Skip to main content
SpringerLink
Log in

Clinical analysis of C5 palsy after cervical decompression surgery: relationship between recovery duration and clinical and radiological factors

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Background

Postoperative C5 palsy is a widely known complication of cervical decompression surgery. Many studies have focused on its etiology and factors affecting it. However, no study to date has evaluated the association between the clinical outcome and recovery duration of post-operative C5 palsy. We evaluated this in our current report.

Methods

A retrospective analysis was conducted for 710 consecutive degenerative cervical spine decompression surgeries performed in a single institution. We included all patients who underwent any type of surgical procedure for cervical spinal stenosis, ossification of posterior longitudinal ligament (OPLL), or cervical spondylotic myelopathy (CSM). Demographic, radiologic, clinical information was recorded. Finally, correlation analysis was conducted to identify demographic, radiologic, or clinical factors related with recovery duration (within or after 6 months).

Results

The incident rate of postoperative C5 palsy was 5.1 % (36/710 cases). Analysis of recovery duration revealed that 18 patients had recovered within 6 months and 33 (91.7 %) within 2 years, whilst 3 individuals (8.3 %) had not fully recovered within the follow-up period. Factors related to longer recovery (>6 months) included motor grade ≤2 (p < 0.001), presence of multi-segment paresis involving more than the C5 root (p = 0.002), loss of somatic sensation with pain (p = 0.008), and the degree of posterior spinal cord shifting (p = 0.040). Furthermore, multivariate analysis revealed that motor grade ≤2 (p = 0.010) had a significant effect on a recovery duration beyond 6 months.

Conclusions

A motor grade ≤2, the presence of multi-segment paresis involving more than the C5 root, the loss of somatic sensation with pain, and the degree of posterior spinal cord shifting significantly influence whether the duration of recovery from postoperative C5 palsy will take longer than 6 months.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Scoville WB (1961) Cervical spondylosis treated by bilateral facetectomy and laminectomy. J Neurosurg 18:423–428. doi:10.3171/jns.1961.18.4.0423

    Article  CAS  PubMed  Google Scholar 

  2. Katsumi K, Yamazaki A, Watanabe K, Ohashi M, Shoji H (2012) Can prophylactic bilateral C4/C5 foraminotomy prevent postoperative C5 palsy after open-door laminoplasty?: a prospective study. Spine (Phila Pa 1976) 37:748–754. doi:10.1097/BRS.0b013e3182326957

    Article  Google Scholar 

  3. Nassr A, Eck JC, Ponnappan RK, Zanoun RR, Donaldson WF 3rd, Kang JD (2012) The incidence of C5 palsy after multilevel cervical decompression procedures: a review of 750 consecutive cases. Spine (Phila Pa 1976) 37:174–178. doi:10.1097/BRS.0b013e318219cfe9

    Article  Google Scholar 

  4. Nakashima H, Imagama S, Yukawa Y, Kanemura T, Kamiya M, Yanase M, Ito K, Machino M, Yoshida G, Ishikawa Y, Matsuyama Y, Hamajima N, Ishiguro N, Kato F (2012) Multivariate analysis of C-5 palsy incidence after cervical posterior fusion with instrumentation. J Neurosurg Spine 17:103–110. doi:10.3171/2012.4.spine11255

    Article  PubMed  Google Scholar 

  5. Imagama S, Matsuyama Y, Yukawa Y, Kawakami N, Kamiya M, Kanemura T, Ishiguro N (2010) C5 palsy after cervical laminoplasty: a multicentre study. J Bone Joint Surg Br 92:393–400. doi:10.1302/0301-620x.92b3.22786

    Article  CAS  PubMed  Google Scholar 

  6. Kaneyama S, Sumi M, Kanatani T, Kasahara K, Kanemura A, Takabatake M, Nakatani T, Yano T (2010) Prospective study and multivariate analysis of the incidence of C5 palsy after cervical laminoplasty. Spine (Phila Pa 1976) 35:E1553–E1558. doi:10.1097/BRS.0b013e3181ce873d

    Article  Google Scholar 

  7. Zhang H, Sun T, Lu S, Li Q, Yadav SK (2012) Comparison of effectiveness between laminoplasty and laminectomy decompression and fusion with internal fixation for cervical spondylotic myelopathy. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 26:1191–1196

    PubMed  Google Scholar 

  8. Liu T, Zou W, Han Y, Wang Y (2010) Correlative study of nerve root palsy and cervical posterior decompression laminectomy and internal fixation. Orthopedics 33. doi:10.3928/01477447-20100625-08

  9. Gu Y, Cao P, Gao R, Tian Y, Liang L, Wang C, Yang L, Yuan W (2014) Incidence and risk factors of C5 palsy following posterior cervical decompression: a systematic review. PLoS One 9:e101933. doi:10.1371/journal.pone.0101933

    Article  PubMed  PubMed Central  Google Scholar 

  10. Sakaura H, Hosono N, Mukai Y, Ishii T, Yoshikawa H (2003) C5 palsy after decompression surgery for cervical myelopathy: review of the literature. Spine (Phila Pa 1976) 28:2447–2451. doi:10.1097/01.BRS.0000090833.96168.3F

    Article  Google Scholar 

  11. Bose B, Sestokas AK, Schwartz DM (2007) Neurophysiological detection of iatrogenic C-5 nerve deficit during anterior cervical spinal surgery. J Neurosurg Spine 6:381–385. doi:10.3171/spi.2007.6.5.381

    Article  PubMed  Google Scholar 

  12. Fan D, Schwartz DM, Vaccaro AR, Hilibrand AS, Albert TJ (2002) Intraoperative neurophysiologic detection of iatrogenic C5 nerve root injury during laminectomy for cervical compression myelopathy. Spine (Phila Pa 1976) 27:2499–2502. doi:10.1097/01.BRS.0000031313.90883.29

    Article  Google Scholar 

  13. Sasai K, Saito T, Akagi S, Kato I, Ohnari H, Iida H (2003) Preventing C5 palsy after laminoplasty. Spine (Phila Pa 1976) 28:1972–1977. doi:10.1097/01.BRS.0000083237.94535.46

    Article  Google Scholar 

  14. Chiba K, Toyama Y, Matsumoto M, Maruiwa H, Watanabe M, Hirabayashi K (2002) Segmental motor paralysis after expansive open-door laminoplasty. Spine (Phila Pa 1976) 27:2108–2115. doi:10.1097/01.BRS.0000025693.11896.B3

    Article  Google Scholar 

  15. Hashimoto M, Mochizuki M, Aiba A, Okawa A, Hayashi K, Sakuma T, Takahashi H, Koda M, Takahashi K, Yamazaki M (2010) C5 palsy following anterior decompression and spinal fusion for cervical degenerative diseases. Eur Spine J 19:1702–1710. doi:10.1007/s00586-010-1427-5

    Article  PubMed  PubMed Central  Google Scholar 

  16. Yang L, Gu Y, Shi J, Gao R, Liu Y, Li J, Yuan W (2013) Modified plate-only open-door laminoplasty versus laminectomy and fusion for the treatment of cervical stenotic myelopathy. Orthopedics 36:e79–e87. doi:10.3928/01477447-20121217-23

    Article  PubMed  Google Scholar 

  17. Hatta Y, Shiraishi T, Hase H, Yato Y, Ueda S, Mikami Y, Harada T, Ikeda T, Kubo T (2005) Is posterior spinal cord shifting by extensive posterior decompression clinically significant for multisegmental cervical spondylotic myelopathy? Spine (Phila Pa 1976) 30:2414–2419

    Article  Google Scholar 

  18. Minoda Y, Nakamura H, Konishi S, Nagayama R, Suzuki E, Yamano Y, Takaoka K (2003) Palsy of the C5 nerve root after midsagittal-splitting laminoplasty of the cervical spine. Spine (Phila Pa 1976) 28:1123–1127. doi:10.1097/01.brs.0000067261.83984.73

    Google Scholar 

  19. Shiozaki T, Otsuka H, Nakata Y, Yokoyama T, Takeuchi K, Ono A, Numasawa T, Wada K, Toh S (2009) Spinal cord shift on magnetic resonance imaging at 24 h after cervical laminoplasty. Spine (Phila Pa 1976) 34:274–279. doi:10.1097/BRS.0b013e318194e275

    Article  Google Scholar 

  20. Komagata M, Nishiyama M, Endo K, Ikegami H, Tanaka S, Imakiire A (2004) Prophylaxis of C5 palsy after cervical expansive laminoplasty by bilateral partial foraminotomy. Spine J 4:650–655. doi:10.1016/j.spinee.2004.03.022

    Article  PubMed  Google Scholar 

  21. Saoud K, El-Shehaby A, El-Shazly A (2013) Surgical management of C5 palsy resulting from posterior spinal decompression for the treatment of cervical spondylotic myelopathy. J Spine 2. doi:10.4172/2165-7939.1000132

  22. Shou F, Li Z, Wang H, Yan C, Liu Q, Xiao C (2015) Prevalence of C5 nerve root palsy after cervical decompressive surgery: a meta-analysis. Eur Spine J 24:2724–2734. doi:10.1007/s00586-015-4186-5

    Article  PubMed  Google Scholar 

  23. Chugh A, Gebhart J, Eubanks J (2015) Predicting postoperative C5 palsy using preoperative spinal cord rotation. Orthopedics 38:e830–e835. doi:10.3928/01477447-20150902-63

    Article  PubMed  Google Scholar 

  24. Bhalodia VM, Schwartz DM, Sestokas AK, Bloomgarden G, Arkins T, Tomak P, Gorelick J, Wijesekera S, Beiner J, Goodrich I (2013) Efficacy of intraoperative monitoring of transcranial electrical stimulation-induced motor evoked potentials and spontaneous electromyography activity to identify acute-versus delayed-onset C-5 nerve root palsy during cervical spine surgery. J Neurosurg Spine 19:395–402

    Article  PubMed  Google Scholar 

  25. Tanaka N, Nakanishi K, Fujiwara Y (2006) Postoperative segmental C5 palsy after cervical laminoplasty may occur without intraoperative nerve injury: a prospective study with transcranial electric motor-evoked potentials. Spine (Phila Pa 1976) 31:3013–3017. doi:10.1097/01.brs.0000250303.17840.96

    Article  Google Scholar 

  26. Jimenez JC, Sani S, Braverman B (2005) Palsies of the fifth cervical nerve root after cervical decompression: prevention using continuous intraoperative electromyography monitoring. J Neurosurg Spine 3:92–97. doi:10.3171/spi.2005.3.2.0092

    Article  PubMed  Google Scholar 

  27. Spitz S, Felbaum D, Aghdam N, Sandhu F (2015) Delayed postoperative C5 root palsy and the use of neurophysiologic monitoring. Eur Spine J 24:2866–2871. doi:10.1007/s00586-015-4252-z

    Article  PubMed  Google Scholar 

  28. Blizzard DJ, Gallizzi MA, Sheets C, Klement MR, Kleeman LT, Caputo AM, Eure M, Brown CR (2015) The role of iatrogenic foraminal stenosis from lordotic correction in the development of C5 palsy after posterior laminectomy and fusion. J Orthop Surg Res 10:160. doi:10.1186/s13018-015-0297-2

    Article  PubMed  PubMed Central  Google Scholar 

  29. Jeon HS, Kim KN (2015) Delayed bilateral C5 palsy following circumferential decompression and fusion in patient with cervical spondylotic myelopathy. Korean J Spine 12(3):200–203. doi:10.14245/kjs.2015.12.3.200

    Article  PubMed  PubMed Central  Google Scholar 

  30. Kiya T, Nakamura Y, Nohara Y (2006) C5 root radiculopathy after cervical laminoplasty [in Japanese]. Bessatsu Seikeigeka 50:13–17

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea

    Chae-Hong Lim, Sung-Woo Roh, Seung-Chul Rhim & Sang-Ryong Jeon

Authors
  1. Chae-Hong Lim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sung-Woo Roh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Seung-Chul Rhim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sang-Ryong Jeon
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sung-Woo Roh.

Ethics declarations

Conflict of interest

The authors report no conflicts of interest concerning the materials or methods used in this study or the findings specified in this paper.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lim, CH., Roh, SW., Rhim, SC. et al. Clinical analysis of C5 palsy after cervical decompression surgery: relationship between recovery duration and clinical and radiological factors. Eur Spine J 26, 1101–1110 (2017). https://doi.org/10.1007/s00586-016-4664-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-016-4664-4

Keywords

Search

Navigation