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

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.