Incidence and prognostic factors of C5 Palsy: A clinical study of 1001 cases and review of the literature

Mohamad Bydon, Mohamed Macki, Paul Kaloostian, Daniel M. Sciubba, Jean Paul Wolinsky, Ziya L. Gokaslan, Allan J. Belzberg, Ali Bydon, Timothy F. Witham

Research output: Contribution to journalArticle

44 Citations (Scopus)

Abstract

BACKGROUND: C5 palsy is a known cause of postoperative deltoid weakness. Prognostic variables affecting the incidence of the palsy have been poorly understood. OBJECTIVE: To determine the incidence and perioperative characteristics/predictors of C5 palsy after anterior vs posterior operations. METHODS: All patients undergoing C4-5 operations for degenerative conditions were retrospectively reviewed over 21 years. Anterior operations included an anterior cervical discectomy and fusion (ACDF) or a corpectomy, whereas posterior operations included laminectomy and fusion (6 foraminotomies). RESULTS: Of the total 1001 operations, in 49.0% anterior and 51.0% posterior cases, there was an overall C5 palsy incidence of 5.2% (52 cases): 1.6% and 8.6%, respectively (P , .001). Of the 99 corpectomies, the palsy incidence of 4.0% was not only higher than ACDFs (1.0%), but also followed an upward trend with increasing corpectomy levels (P = .009). Of the 69 posterior and 83 anterior C4-5 foraminotomies, the incidence of C5 palsy was statistically higher in the posterior (14.5%) vs anterior (2.4%) cohort (P = .01). Multiple logistical regression identified older age as the strongest predictor of C5 palsy in the anterior (P = .02) and C4-5 foraminotomy in the posterior (P = .06) cohort. This condition improved within 3 to 6 months in 75% of patients in the anterior and 88.6% in the posterior cohort after a mean follow-up of 14.4 and 27.6 months, respectively. CONCLUSION: In one of the largest cohorts on C5 palsy, we found in anterior operations an increasing number of corpectomy levels had a higher incidence of C5 palsy; however, older age was the strongest predictor of C5 palsy. In posterior operations, C4-5 foraminotomy carried the strongest correlation.

Original languageEnglish (US)
Pages (from-to)595-604
Number of pages10
JournalNeurosurgery
Volume74
Issue number6
DOIs
StatePublished - 2014
Externally publishedYes

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Paralysis
Foraminotomy
Incidence
Clinical Studies
Diskectomy
Laminectomy

Keywords

  • ACDF
  • Age
  • C5 palsy
  • Corpectomy
  • Foraminotomy
  • Fusion
  • Laminectomy

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Medicine(all)

Cite this

Bydon, M., Macki, M., Kaloostian, P., Sciubba, D. M., Wolinsky, J. P., Gokaslan, Z. L., ... Witham, T. F. (2014). Incidence and prognostic factors of C5 Palsy: A clinical study of 1001 cases and review of the literature. Neurosurgery, 74(6), 595-604. https://doi.org/10.1227/NEU.0000000000000322

Incidence and prognostic factors of C5 Palsy : A clinical study of 1001 cases and review of the literature. / Bydon, Mohamad; Macki, Mohamed; Kaloostian, Paul; Sciubba, Daniel M.; Wolinsky, Jean Paul; Gokaslan, Ziya L.; Belzberg, Allan J.; Bydon, Ali; Witham, Timothy F.

In: Neurosurgery, Vol. 74, No. 6, 2014, p. 595-604.

Research output: Contribution to journalArticle

Bydon, M, Macki, M, Kaloostian, P, Sciubba, DM, Wolinsky, JP, Gokaslan, ZL, Belzberg, AJ, Bydon, A & Witham, TF 2014, 'Incidence and prognostic factors of C5 Palsy: A clinical study of 1001 cases and review of the literature', Neurosurgery, vol. 74, no. 6, pp. 595-604. https://doi.org/10.1227/NEU.0000000000000322
Bydon, Mohamad ; Macki, Mohamed ; Kaloostian, Paul ; Sciubba, Daniel M. ; Wolinsky, Jean Paul ; Gokaslan, Ziya L. ; Belzberg, Allan J. ; Bydon, Ali ; Witham, Timothy F. / Incidence and prognostic factors of C5 Palsy : A clinical study of 1001 cases and review of the literature. In: Neurosurgery. 2014 ; Vol. 74, No. 6. pp. 595-604.
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abstract = "BACKGROUND: C5 palsy is a known cause of postoperative deltoid weakness. Prognostic variables affecting the incidence of the palsy have been poorly understood. OBJECTIVE: To determine the incidence and perioperative characteristics/predictors of C5 palsy after anterior vs posterior operations. METHODS: All patients undergoing C4-5 operations for degenerative conditions were retrospectively reviewed over 21 years. Anterior operations included an anterior cervical discectomy and fusion (ACDF) or a corpectomy, whereas posterior operations included laminectomy and fusion (6 foraminotomies). RESULTS: Of the total 1001 operations, in 49.0{\%} anterior and 51.0{\%} posterior cases, there was an overall C5 palsy incidence of 5.2{\%} (52 cases): 1.6{\%} and 8.6{\%}, respectively (P , .001). Of the 99 corpectomies, the palsy incidence of 4.0{\%} was not only higher than ACDFs (1.0{\%}), but also followed an upward trend with increasing corpectomy levels (P = .009). Of the 69 posterior and 83 anterior C4-5 foraminotomies, the incidence of C5 palsy was statistically higher in the posterior (14.5{\%}) vs anterior (2.4{\%}) cohort (P = .01). Multiple logistical regression identified older age as the strongest predictor of C5 palsy in the anterior (P = .02) and C4-5 foraminotomy in the posterior (P = .06) cohort. This condition improved within 3 to 6 months in 75{\%} of patients in the anterior and 88.6{\%} in the posterior cohort after a mean follow-up of 14.4 and 27.6 months, respectively. CONCLUSION: In one of the largest cohorts on C5 palsy, we found in anterior operations an increasing number of corpectomy levels had a higher incidence of C5 palsy; however, older age was the strongest predictor of C5 palsy. In posterior operations, C4-5 foraminotomy carried the strongest correlation.",
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T1 - Incidence and prognostic factors of C5 Palsy

T2 - A clinical study of 1001 cases and review of the literature

AU - Bydon, Mohamad

AU - Macki, Mohamed

AU - Kaloostian, Paul

AU - Sciubba, Daniel M.

AU - Wolinsky, Jean Paul

AU - Gokaslan, Ziya L.

AU - Belzberg, Allan J.

AU - Bydon, Ali

AU - Witham, Timothy F.

PY - 2014

Y1 - 2014

N2 - BACKGROUND: C5 palsy is a known cause of postoperative deltoid weakness. Prognostic variables affecting the incidence of the palsy have been poorly understood. OBJECTIVE: To determine the incidence and perioperative characteristics/predictors of C5 palsy after anterior vs posterior operations. METHODS: All patients undergoing C4-5 operations for degenerative conditions were retrospectively reviewed over 21 years. Anterior operations included an anterior cervical discectomy and fusion (ACDF) or a corpectomy, whereas posterior operations included laminectomy and fusion (6 foraminotomies). RESULTS: Of the total 1001 operations, in 49.0% anterior and 51.0% posterior cases, there was an overall C5 palsy incidence of 5.2% (52 cases): 1.6% and 8.6%, respectively (P , .001). Of the 99 corpectomies, the palsy incidence of 4.0% was not only higher than ACDFs (1.0%), but also followed an upward trend with increasing corpectomy levels (P = .009). Of the 69 posterior and 83 anterior C4-5 foraminotomies, the incidence of C5 palsy was statistically higher in the posterior (14.5%) vs anterior (2.4%) cohort (P = .01). Multiple logistical regression identified older age as the strongest predictor of C5 palsy in the anterior (P = .02) and C4-5 foraminotomy in the posterior (P = .06) cohort. This condition improved within 3 to 6 months in 75% of patients in the anterior and 88.6% in the posterior cohort after a mean follow-up of 14.4 and 27.6 months, respectively. CONCLUSION: In one of the largest cohorts on C5 palsy, we found in anterior operations an increasing number of corpectomy levels had a higher incidence of C5 palsy; however, older age was the strongest predictor of C5 palsy. In posterior operations, C4-5 foraminotomy carried the strongest correlation.

AB - BACKGROUND: C5 palsy is a known cause of postoperative deltoid weakness. Prognostic variables affecting the incidence of the palsy have been poorly understood. OBJECTIVE: To determine the incidence and perioperative characteristics/predictors of C5 palsy after anterior vs posterior operations. METHODS: All patients undergoing C4-5 operations for degenerative conditions were retrospectively reviewed over 21 years. Anterior operations included an anterior cervical discectomy and fusion (ACDF) or a corpectomy, whereas posterior operations included laminectomy and fusion (6 foraminotomies). RESULTS: Of the total 1001 operations, in 49.0% anterior and 51.0% posterior cases, there was an overall C5 palsy incidence of 5.2% (52 cases): 1.6% and 8.6%, respectively (P , .001). Of the 99 corpectomies, the palsy incidence of 4.0% was not only higher than ACDFs (1.0%), but also followed an upward trend with increasing corpectomy levels (P = .009). Of the 69 posterior and 83 anterior C4-5 foraminotomies, the incidence of C5 palsy was statistically higher in the posterior (14.5%) vs anterior (2.4%) cohort (P = .01). Multiple logistical regression identified older age as the strongest predictor of C5 palsy in the anterior (P = .02) and C4-5 foraminotomy in the posterior (P = .06) cohort. This condition improved within 3 to 6 months in 75% of patients in the anterior and 88.6% in the posterior cohort after a mean follow-up of 14.4 and 27.6 months, respectively. CONCLUSION: In one of the largest cohorts on C5 palsy, we found in anterior operations an increasing number of corpectomy levels had a higher incidence of C5 palsy; however, older age was the strongest predictor of C5 palsy. In posterior operations, C4-5 foraminotomy carried the strongest correlation.

KW - ACDF

KW - Age

KW - C5 palsy

KW - Corpectomy

KW - Foraminotomy

KW - Fusion

KW - Laminectomy

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