Incidence and Risk Factors of C5 Palsy following Posterior Cervical Decompression: A Systematic Review

Abstract

BackgroundC5 palsy is a serious but poorly understood complication after posterior cervical decompression that could lead to muscle weakness, brachialgia and numbness of the upper limbs. The incidence of C5 palsy varies greatly between studies. The risk factors are inconclusive and even conflicting.ObjectTo perform a systematic review on the incidence and risk factors of C5 palsy after posterior cervical decompression.Materials and MethodsFour databases, PubMed, Embase, Web of Science and Cochrane CENTRAL, were searched to identify eligible studies. Either a fixed- or a random-effects model was used to calculate the pooled odd ratio (RR) or standardized mean difference (SMD) with its 95% confidence interval (95%CI).ResultsOf the 589 pre-recruited studies, 25 were included in this study for systematic review. The pooled incidence of C5 palsy after posterior decompression was 5.8% (95%CI: 4.4–7.2%). The incidence after open-door laminoplasty, double-door laminoplasty and laminectomy was 4.5%, 3.1% and 11.3%, respectively. The significant risk factors of C5 palsy were OPLL (OR, 2.188; 95%CI, 1.307–3.665), narrower intervertebral foramen (SMD, −0.972; 95%CI, −1.398 to −0.545), laminectomy (vs. open-door laminoplasty, OR, 2.988; 95%CI, 1.298–6.876), excessive spinal cord drift (SMD, 1.289, 95%CI, 0,197–2.381) and male gender (OR, 1.54; 95%CI, 1.036–2.301).ConclusionsThe results of this systematic review suggest that patients with excessive spinal cord drift, preexisting intervertebral foramenal stenosis, OPLL, laminectomy and male gender are at high risk for postoperative C5 palsy, and risk-reduction options should be considered for such patients.

C5 nerve root palsy after posterior cervical spine surgery

“…11,12 Although many studies on C5 palsy after posterior cervical surgery have been published, the results are often inconclusive and even conflicting. 13,14 Here, we provide a systematic review of the current literature and attempt to analyze the conflicting results among studies to better understand the clinical features, influencing factors, and preventive measures of C5 palsy after posterior cervical surgery.…”

Comparison of anterior approach versus posterior approach for the treatment of multilevel cervical spondylotic myelopathy

“…However, if posterior shift of the cord is not sufficient, ventral constriction of the cord may persist, leading to decreased recovery from myelopathy. Some authors have recognized the complications of this procedure, including axial pain and C5 root palsy [8][9][10]. Further, some studies have reported that patients who undergo posterior laminoplasty or laminectomy are more likely to suffer from cervical kyphosis or instability than those who receive treatment via anterior approaches [11][12][13].…”

Multiple level anterior cervical discectomy and fusion versus posterior laminectomy for the management of multilevel cervical spondylotic myelopathy: clinical and radiological outcome

“…Similarly, Wang et al [17] noted that ACDF using a stand-alone cage was associated with significantly less blood loss compared with a posterior approach, while operative time was similar for both procedures. A previous study shows that C5 nerve root palsy is more likely to happen in patients who undergo posterior decompression compared with ACDF following excessive spinal cord drift after laminectomy [24]; postoperative C5 palsy may also associate the presence of C4-5 high intensity cord signal changes or a long duration of symptoms [25]. In the meta-analysis by Shou et al [26], the highest prevalence of C5 palsy was noted among the patients who had laminectomy and fusion (11.0%), in contrast to (3.3%) in the ACDF group.…”