C5 Palsy After Cervical Decompression: A 10-Year Single-Institution Study Highlighting Early Onset, High Bilaterality, and Poor Recovery

Introduction: C5 palsy is a recognized complication following cervical decompression procedures, presenting as new-onset deltoid or biceps weakness. Despite extensive investigation, its mechanisms remain debated, involving root traction, foraminal stenosis, and possible cord-level ischemia-reperfusion injury. Reported incidences vary widely, and recovery outcomes differ across populations, making institutional data valuable. Study: This retrospective observational study evaluated postoperative C5 palsy over a 10-year period in patients undergoing cervical decompression. All cases were assessed for incidence, timing of onset, laterality, surgical approach, and long-term neurological outcomes. Additional emphasis was placed on identifying patterns that differ from those in the existing literature, particularly regarding severity and bilaterality. Results: Among 198 cervical decompressions, 14 patients (7.1%) developed C5 palsy. Early onset was universal, with 57.1% (eight patients) occurring immediately postoperatively. Bilateral involvement was unusually high at 35.7% (five patients). Eight patients (57.1%) exhibited persistent deficits, while three patients (21.4%) worsened; only three patients (21.4%) showed improvement, and none recovered full strength. Posterior approaches accounted for 71.4% of cases, and foraminal stenosis was present in five patients (35.7%). Conclusion: C5 palsy in this cohort showed early onset, high bilaterality, and poor recovery, suggesting multifactorial mechanisms rather than isolated root traction. Posterior approaches and foraminal stenosis appear to be important risk factors. Preventive strategies should include detailed imaging, selective foraminotomy, neuromonitoring, and refined surgical technique. Further multicenter studies are needed to clarify pathogenesis and improve outcomes.