9. C5 palsy after cervical laminectomy: natural history and risk factors in a 10-year series

Abstract

BACKGROUND CONTEXT Palsy of the fifth cervical nerve (C5) is a well-known complication of cervical laminectomy, occurring in 1-30% of cases. PURPOSE To determine the incidence of C5 palsy after posterior cervical decompression at a single institution. STUDY DESIGN/SETTING Retrospective chart review at a tertiary care academic medical center. PATIENT SAMPLE 214 patients undergoing posterior cervical decompression. OUTCOME MEASURES Development of C5 palsy postoperatively, and recovery of function in patients with new onset C5 palsy. METHODS A retrospective chart review identified patients undergoing first time cervical laminectomy for degenerative spine pathologies at a single institution between January 2008 and July 2018. Patients were included if a complete laminectomy was performed at C4 or C5. Patients with a history of prior cervical spine surgery, concurrent anterior surgery, intradural pathology, spinal tumor, or spinal trauma were excluded. Patient history, surgical specifics, and neurologic function were recorded. RESULTS A total of 214 patients were treated by 15 surgeons; 60 patients (28%) developed C5 palsy postoperatively. Of patients with C5 palsy, 47 (78%) recovered to baseline strength, 87% had at least grade 4 strength at last follow-up, and 4 (7%) had strength worse than baseline and grade less than 3. Mean time to recovery was 8 months (max 7 years). Mean length of follow-up was 22 months [AJ1]. Age, gender, vertebral levels involved, and comorbidities were not associated with a significant increase in risk of C5 stretch, or failure to recover. Fusion including the upper thoracic spine was associated with an increased risk of C5 palsy (38.6% vs 28%; p=0.019). CONCLUSIONS This represents one of the largest reported series of patients with postoperative C5 palsy. Overall prognosis is good, but the risk of C5 injury after first time cervical laminectomy may be higher than most prior reports. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.