Incidence of C5 Palsy and Recovery Rate After Cervical Spine Surgery: A Systematic Review and Meta-Analysis

C5 nerve palsy is a debilitating complication of cervical spine surgery that can occur after certain approaches. To our knowledge, no previous systematic reviews have compared the rates of C5 nerve palsy after different cervical approaches, identifying the rate at which this complication becomes permanent. We aimed to compare the rates of C5 palsy after different cervical spine surgery approaches and the rates of recovery when C5 palsy was present. A literature search of the PubMed and Embase databases from their inception to July 1, 2023, was completed to identify studies that focused on cervical spine surgery. Studies were excluded if they did not provide the rate of C5 palsy occurrence or define which surgical approaches were used. A pooled, weighted prevalence rate of C5 palsy was calculated for each approach, including the rate of permanent C5 palsy. A total of 155 studies met the inclusion criteria. Of these studies, 22 (14.2%) reported on laminectomies, 77 (49.7%) on laminoplasties, 38 (24.5%) on posterior cervical decompression and fusion, 39 (25.2%) on anterior cervical diskectomy and fusion, and 4 (2.6%) on corpectomies. Patients who had laminectomies had the highest incidence of C5 palsy at a pooled rate of 8%, of which 1.44% of cases were permanent. This was followed by posterior cervical decompression and fusion with a rate of 7.03% and a permanence rate of 1.02%. Patients receiving laminoplasties had a C5 palsy incidence of 5.11%; of these, 0.28% of cases were permanent. Patients who had corpectomies had an incidence of 4.16%; those who had anterior cervical diskectomy and fusions had the lowest incidence of 2.61%, of which 1.06% of cases were permanent. C5 nerve palsy is a known complication after cervical spine surgeries, with increased rates in posterior approaches, although the rate of these complications becoming permanent is minimal.