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Neurosurgery. 2014 Jun;74(6):595-604; discussion 604-5. doi: 10.1227/NEU.0000000000000322.

Incidence and prognostic factors of c5 palsy: a clinical study of 1001 cases and review of the literature.

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1
‡Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; §Johns Hopkins Spinal Biomechanics and Surgical Outcomes Laboratory, Baltimore, Maryland.

Abstract

BACKGROUND:

C5 palsy is a known cause of postoperative deltoid weakness. Prognostic variables affecting the incidence of the palsy have been poorly understood.

OBJECTIVE:

To determine the incidence and perioperative characteristics/predictors of C5 palsy after anterior vs posterior operations.

METHODS:

All patients undergoing C4-5 operations for degenerative conditions were retrospectively reviewed over 21 years. Anterior operations included an anterior cervical discectomy and fusion (ACDF) or a corpectomy, whereas posterior operations included laminectomy and fusion (± foraminotomies).

RESULTS:

Of the total 1001 operations, in 49.0% anterior and 51.0% posterior cases, there was an overall C5 palsy incidence of 5.2% (52 cases): 1.6% and 8.6%, respectively (P < .001). Of the 99 corpectomies, the palsy incidence of 4.0% was not only higher than ACDFs (1.0%), but also followed an upward trend with increasing corpectomy levels (P = .009). Of the 69 posterior and 83 anterior C4-5 foraminotomies, the incidence of C5 palsy was statistically higher in the posterior (14.5%) vs anterior (2.4%) cohort (P = .01). Multiple logistical regression identified older age as the strongest predictor of C5 palsy in the anterior (P = .02) and C4-5 foraminotomy in the posterior (P = .06) cohort. This condition improved within 3 to 6 months in 75% of patients in the anterior and 88.6% in the posterior cohort after a mean follow-up of 14.4 and 27.6 months, respectively.

CONCLUSION:

In one of the largest cohorts on C5 palsy, we found in anterior operations an increasing number of corpectomy levels had a higher incidence of C5 palsy; however, older age was the strongest predictor of C5 palsy. In posterior operations, C4-5 foraminotomy carried the strongest correlation.

PMID:
24561867
DOI:
10.1227/NEU.0000000000000322
[Indexed for MEDLINE]
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