C5 Palsy After Cervical Decompression Procedures

Study Design Review of literature. Objectives To review the literature regarding the clinical features, incidence, underlying mechanism, possible prevention, and prognosis of C5 palsy after cervical decompression surgery. Summary of Background Data Palsy of the C5 nerve after cervical spine decompression surgery is a well-known complication. There is persistent controversy concerning the underlying mechanism and appropriate prophylaxis. Methods A review of studies describing C5 palsy after cervical spine decompression procedures was carried out. Results Postoperative C5 palsy can be present after cervical spine decompression with a reported incidence between 0% and 50%. Postoperative C5 palsy has been reported regardless of the underlying cause of cervical spinal cord compression and the surgical procedure carried out. The current literature describes 5 basic underlying mechanisms. These include direct injury to the nerve root, segmental spinal cord pathology, progressive cervical spine malalignment and instability, nerve root traction, and abnormal spinal cord blood flow and reperfusion injury. The true pathomechanism of postoperative C5 palsy remains unclear and no single method of prevention is regularly used. The prognosis of postoperative C5 palsy is generally good with full recovery reported in the majority of patients. Conclusions Postoperative C5 palsy is a complication seen after surgical decompression of the cervical spine. It can occur regardless of the cause of cervical spinal cord compression and the surgical procedure carried out. Numerous theories exist as to the underlying cause of postoperative C5 palsy, but there is no strong evidence to support any single pathomechanism or appropriate prophylaxis. Most patients with postoperative C5 palsy experience full recovery within 6 months, although many patients continue to have some residual pain or neurologic deficit.