Impact of postoperative C5 palsy on quality of life in patients with cervical ossification of the posterior longitudinal ligament: a prospective study.

OBJECTIVE

The impact of C5 palsy on quality of life (QOL) and its relationship with recovery and overall well-being remain poorly understood. In this study, the authors aimed to examine the effects of postoperative C5 palsy on upper extremity function and QOL in patients undergoing cervical ossification of the posterior longitudinal ligament (C-OPLL) surgery, using both objective clinical assessments and patient-reported outcome measures (PROMs). Additionally, this study aimed to explore the correlation between residual C5 palsy and QOL over a 2-year period.

METHODS

This retrospective study, using a prospective multicenter database, included 478 patients with myelopathy caused by C-OPLL, treated between 2014 and 2018, with a 2-year follow-up. Thirty-one patients developed postoperative C5 palsy (C5 palsy group), and their outcomes were compared to those of 389 patients without C5 palsy (non-C5 palsy group) using propensity score matching. Within the C5 palsy group, patients were further classified based on their recovery status at 1 year postoperatively. Neurological status was assessed using the Japanese Orthopaedic Association (JOA) score, while PROMs were evaluated using the JOA Cervical Myelopathy Evaluation Questionnaire, which assesses cervical and upper extremity function, bladder function, and overall QOL. Assessments were conducted at 6 months, 1 year, and 2 years postoperatively.

RESULTS

C5 palsy occurred in 7.4% of patients, with 61.3% achieving full recovery within 1 year. Patients in the C5 palsy group had significantly poorer upper extremity function and shoulder motor scores than those in the non-C5 palsy group at all postoperative time points. However, no significant differences were observed between the groups in QOL, cervical function, lower extremity function, or bladder function. In contrast, patients with residual C5 palsy had worse QOL as well as upper extremity function compared to patients with recovered C5 palsy.

CONCLUSIONS

While postoperative C5 palsy continues to affect motor and upper extremity function beyond 1 year, QOL scores were not significantly lower in the C5 palsy group. However, the impact on QOL in patients with residual C5 palsy may continue to slightly improve over time.