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

46 Scopus citations

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 - Jun 2014

Keywords

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

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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    Bydon, M., Macki, M., Kaloostian, P., Sciubba, D. M., Wolinsky, J. P., Gokaslan, Z. L., Belzberg, A. J., Bydon, A., & 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