1068 Incidence and Recovery of C5 Nerve Palsy After Various Types of Cervical Spinal Surgery: A Systematic Review and Meta-Analysis of Over 14,834 Patients

Abstract

INTRODUCTION: C5 nerve palsy is a debilitating operative complication of cervical surgery and occurs commonly as many surgical approaches operate near the exiting nerve root. No prior study has attempted to identify the recovery rate of C5 nerve palsy after cervical operations, and identify the rate of which this complication becomes permanent. METHODS: A literature search of the PubMed and Embase databases was completed to identify all papers focused on cervical surgery. Studies were excluded if they did not provide the rate of C5 palsy occurrence or if they did not define what type of cervical surgery was completed. A pooled, weighted prevalence rate of C5 palsy was calculated for each type of surgery, including the rate of these becoming permanent. RESULTS: A total of 118 studies were identified and met all inclusion criteria. Of these studies, 52 were focused on laminoplasties, 24 on anterior cervical discectomy fusions (ACDF), 22 on laminectomies without fusion, and 20 on posterior cervical fusions (PCF). Laminectomies had the highest incidence of C5 palsy at a pooled rate of 7.08% (95% Confidence Interval [CI], 4.74%-10.46%, I2 = 87%, P < .01), of which 0.05% (CI = 0.00%-0.90%) were permanent. This was followed by PCFs with a rate of 6.70% (CI = 4.50%-9.85%), with the effects being permanent at a rate of 0.04% (CI = 0.00%-1.20%). Laminoplasties had a C5 palsy incidence of 5.49% (CI = 4.65%-6.47%), of these 0.02% (CI = 0.00%-0.11%) were permanent. ACDFs had the lowest incidence at a rate of 4.50% (CI = 2.56%-7.79%), of which only 0.02% (CI = 0.04%-0.08%) were permanent. CONCLUSIONS: C5 nerve palsy is a relatively common complication after all types of cervical surgeries with increased rates in posterior approaches, however the rate of these becoming permanent is minimal.