Cord-lamina angle and foraminal diameter as key predictors of C5 palsy after anterior cervical decompression and fusion surgery.

BACKGROUND

C5 nerve root palsy (C5P) is a rare but documented complication after cervical decompression surgery. Despite multiple proposed mechanisms, research on risk factors for C5P after anterior cervical discectomy and fusion (ACDF) remains insufficient.

OBJECTIVE

The aim of this study was to identify specific risk factors associated with C5 nerve root palsy after ACDF.

METHODS

A total of 108 patients who underwent ACDF surgery were divided into C5P and non-C5P groups. The basic data, preoperative Japanese Orthopaedic Association score, cervical curvature correction at C2-7 and C4-5, anterior-posterior diameter (APD) at C4/5, spinal-cord-lumbar angle (CLA) at C4/5, foramen magnum occipitalis at C4/5, and the presence of preoperative high-signal areas in the C4/5 spinal cord on T2-weighted magnetic resonance imaging, were present. Risk factors associated with C5P were identified using logistic regression analysis.

RESULTS

There were no significant differences between the two groups in terms of age, gender, disease duration, diagnosis, preoperative Japanese Orthopaedic Association score, number of operated segments, APD, or high-intensity zone. LRA showed that a larger CLA and narrower FD at C4/5 were the main risk factors for the development of C5P (P < 0.05).

CONCLUSION

A larger cord-lamina angle and a narrower foraminal diameter at C4/5 are significant risk factors associated with the development of C5 palsy following ACDF.