C5 palsy after C5/6/7 posterior foraminal decompression

Abstract

Rationale: Although C5 palsy is a common complication of cervical spine surgery, its cause has not been confirmed. There are various hypotheses for its mechanism, including spinal cord impairment and nerve involvement. Therefore, prophylactic foraminotomy is one of the methods recommended for preventing C5 palsy. However, we describe a patient who experienced C5 palsy after microendoscopic foraminotomy between the left C5/6 and C6/7 levels. Patient concerns: A 43-year-old man presented with a 14-month history of progressive numbness in the left upper limb. We performed microendoscopic left foraminal decompressions at the C5/6/7 levels to treat the left C6 and C7 radiculopathy. On the postoperative day 1, we observed weak motor strength of the left deltoid, left biceps, and left forearm pronator, while the motor strength of the other muscles was normal. Diagnoses: C5 palsy following C5/6/7 left foraminotomy. Intervention: Follow-up rehabilitation with muscle strength training and range of motion training. Outcome: The patient recovered his motor strength completely within 3 months postoperatively. Lessons: In this case, the C5 palsy could not be adequately explained by the theory of nerve root impingement or disruption in blood circulation following spinal cord decompression. We hypothesized that the patient had drill heat-induced C5 palsy. Regarding the C5 palsy without C5 nerve root decompression, we hypothesize that the C5 palsy in C5/6/7 foraminotomy could be related to variations in the formation of the brachial plexus. Prophylactic foraminotomy for cervical posterior surgery should be performed with care, limiting its use in patients who are at a risk of developing C5 palsy because the prophylactic procedure can cause C5 palsy. We must also consider that even without decompression at the C4/5 level, there is a possibility of C5 palsy occurring.

C5 palsy in the treatment of cervical spondylosis myelopathy with ossification of the posterior longitudinal ligament

“…Inflammatory responses are known as a major component of secondary injury of initial ischemic insult and play an important role in modulating the pathogenesis of C5 palsy [37,8,24,20]. Effects of reperfusion, also known as reperfusion injury, are the causative factors for spinal edema [38,25,8,18]. The results of this study shown the complication of C5 palsy in PCDL were serve than ACCF may be related the spinal ischemia and reperfusion injury.…”

“…[15,8] However, the complication of C5 palsy were not diminished with the development of anterior and posterior surgery. [16][17][18] The complication of C5 palsy, which been considered main in the posterior surgery, have been found still in the anterior surgery of CSM, especially in OPLL. [19,13,1,9,20,21] The C5 palsy in OPLL patients was the cervical spinal cord injuries, which different from other spinal cord injuries because of ossification induced narrowing of the spinal canal and limitation of intervertebral mobility.…”

“…[19,13,1,9,20,21] The C5 palsy in OPLL patients was the cervical spinal cord injuries, which different from other spinal cord injuries because of ossification induced narrowing of the spinal canal and limitation of intervertebral mobility. [21,22,18,20] There are many factors that affect the C5 palsy in surgical treatment of OPLL, but the spinal canal stenosis and the spinal compression degrees may be an important factor in affection on it. The purpose of this study was to evaluate the effect of spinal canal stenosis and spinal cord compression degrees on the clinical outcomes of OPLL patients which been treated by anterior or posterior surgery in our clinical.…”