281. C5 palsy and neurological complications after cervical spine surgery

Abstract

BACKGROUND CONTEXT Neurologic complications of cervical spine surgery include C5 palsy, monoplegia, paraplegia and quadriplegia and can have significant impact on quality of life. C5 palsy has a reported incidence of 0-30% with few well-established risk factors. Postoperative cervical spine iatrogenic monoplegia, paraplegia and quadriplegia have little literature supporting their incidence. The Charlson Comorbidity Index is a measure of comorbidity in patients that is associated with surgical outcomes. PURPOSE The objective of this study was to identify the incidence and risk factors for severe neurological complications including C5 palsy after cervical spine surgery using a nationwide patient database. STUDY DESIGN/SETTING Retrospective database study. PATIENT SAMPLE Patients from the Humana national database who underwent cervical spine surgery between 2007 and 2016. OUTCOME MEASURES Neurological complications, CCI, patient demographics. METHODS The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9), The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10), and Current Procedural Terminology (CPT) codes were used to identify and evaluate patients from the Humana national database for neurological complications following posterior fusion cervical spine surgery, anterior fusion cervical spine surgery, laminectomy/laminotomy of the cervical spine, and artificial disc replacement of the cervical spine. Neurological complications were evaluated over a 14-day postoperative period. Using Chi-squared testing, complication incidences and relative risk ratios were calculated with respect to type of cervical spine surgery, CCI, patient age, and patient sex. RESULTS A total of 45,373 patients from the Humana database fit the inclusion criteria for cervical spine surgery. Of these, 732 (1.61%) patients experienced a neurological complication within 14 days after cervical spine surgery. C5 palsy had an incidence of 0.06% across all cervical spine surgeries (29 of 45,373 patients). A CCI >3 had a 5.44 times relative risk for any neurological complication (RR: 5.44; 95% CI: 4.70 - 6.30; p CONCLUSIONS Patients who underwent cervical spine surgery and had a CCI > 3 were at a significantly increased relative risk for neurological complications including C5 palsy within 14 days after surgery. Compared to female patients, male patients had a statistically significant increased incidence in neurological complications, but no significant increase in incidence for C5 palsy. Posterior fusion cervical spine surgery had the highest incidence of neurological complications. Age was correlated with greater incidence of neurological complications. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.