C5 Palsy After Cervical Spine Surgery: A Multicenter Retrospective Review of 59 Cases

Sara E Thompson; Zachary A Smith; Wellington K Hsu; Ahmad Nassr; Thomas E Mroz; David E Fish; Jeffrey C Wang; Michael G Fehlings; Chadi A Tannoury; Tony Tannoury; P Justin Tortolani; Vincent C Traynelis; Ziya Gokaslan; Alan S Hilibrand; Robert E Isaacs; Praveen V Mummaneni; Dean Chou; Sheeraz A Qureshi; Samuel K Cho; Evan O Baird; Rick C Sasso; Paul M Arnold; Zorica Buser; Mohamad Bydon; Michelle J Clarke; Anthony F De Giacomo; Adeeb Derakhshan; Bruce Jobse; Elizabeth L Lord; Daniel Lubelski; Eric M Massicotte; Michael P Steinmetz; Gabriel A Smith; Jonathan Pace; Mark Corriveau; Sungho Lee; Peter I Cha; Dhananjay Chatterjee; Erica L Gee; Erik N Mayer; Owen J McBride; Allison K Roe; Marisa Y Yanez; D Alex Stroh; Khoi D Than; K Daniel Riew

doi:10.1177/2192568216688189

C5 Palsy After Cervical Spine Surgery: A Multicenter Retrospective Review of 59 Cases

Global Spine J. 2017 Apr;7(1 Suppl):64S-70S. doi: 10.1177/2192568216688189. Epub 2017 Apr 1.

Authors

Sara E Thompson¹, Zachary A Smith¹, Wellington K Hsu¹, Ahmad Nassr², Thomas E Mroz³, David E Fish^{4

5}, Jeffrey C Wang⁶, Michael G Fehlings⁷, Chadi A Tannoury⁸, Tony Tannoury⁸, P Justin Tortolani^{9

10}, Vincent C Traynelis¹¹, Ziya Gokaslan^{12

13

14

15}, Alan S Hilibrand¹⁶, Robert E Isaacs¹⁷, Praveen V Mummaneni¹⁸, Dean Chou¹⁸, Sheeraz A Qureshi^{19

20}, Samuel K Cho²⁰, Evan O Baird¹⁹, Rick C Sasso²¹, Paul M Arnold²², Zorica Buser²³, Mohamad Bydon², Michelle J Clarke², Anthony F De Giacomo⁷, Adeeb Derakhshan³, Bruce Jobse²⁴, Elizabeth L Lord⁵, Daniel Lubelski²⁴, Eric M Massicotte^{7

25}, Michael P Steinmetz²⁶, Gabriel A Smith²⁷, Jonathan Pace²⁷, Mark Corriveau²⁸, Sungho Lee²⁷, Peter I Cha⁵, Dhananjay Chatterjee⁵, Erica L Gee⁵, Erik N Mayer⁵, Owen J McBride⁵, Allison K Roe⁵, Marisa Y Yanez⁵, D Alex Stroh⁸, Khoi D Than²⁹, K Daniel Riew^{30

31}

Affiliations

¹ Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
² Mayo Clinic, Rochester, MN, USA.
³ Cleveland Clinic, Cleveland, OH, USA.
⁴ The UCLA Spine Center, Santa Monica, CA, USA.
⁵ University of California, Los Angeles, CA, USA.
⁶ USC Spine Center, Los Angeles, CA, USA.
⁷ Toronto Western Hospital, Toronto, Ontario, Canada.
⁸ Boston University Medical Center, Boston, MA, USA.
⁹ Medstar Union Memorial Hospital, Baltimore, MD, USA.
¹⁰ Johns Hopkins Medical Institutions, Baltimore, MD, USA.
¹¹ Rush University Medical Center, Chicago, IL, USA.
¹² Brown University, Providence, RI, USA.
¹³ The Miriam Hospital, Providence, RI, USA.
¹⁴ Rhode Island Hospital, Providence, RI, USA.
¹⁵ Norman Prince Neurosciences Institute, Providence, RI, USA.
¹⁶ Jefferson Medical College, The Rothman Institute, Philadelphia, PA, USA.
¹⁷ Duke University Medical Center, Durham, NC, USA.
¹⁸ University of California, San Francisco, CA, USA.
¹⁹ Mount Sinai Hospital, New York, NY, USA.
²⁰ Icahn School of Medicine at Mount Sinai, New York, NY, USA.
²¹ Indiana University, Indianapolis, IN, USA.
²² Kansas University Medical Center, Kansas City, KS, USA.
²³ University of Southern California, Los Angeles, CA, USA.
²⁴ Boston Medical Center, Scituate, MA, USA.
²⁵ University of Toronto, Toronto, Ontario, Canada.
²⁶ Cleveland Clinic Foundation, Cleveland, OH, USA.
²⁷ University Hospitals Case Medical Center, Cleveland, OH, USA.
²⁸ University of Wisconsin Hospital and Clinics, Madison, WI, USA.
²⁹ Oregon Health & Science University, Portland, OR, USA.
³⁰ Columbia University, New York, NY, USA.
³¹ New York-Presbyterian/The Allen Hospital, New York, NY, USA.

Abstract

Study design: A multicenter, retrospective review of C5 palsy after cervical spine surgery.

Objective: Postoperative C5 palsy is a known complication of cervical decompressive spinal surgery. The goal of this study was to review the incidence, patient characteristics, and outcome of C5 palsy in patients undergoing cervical spine surgery.

Methods: We conducted a multicenter, retrospective review of 13 946 patients across 21 centers who received cervical spine surgery (levels C2 to C7) between January 1, 2005, and December 31, 2011, inclusive. P values were calculated using 2-sample t test for continuous variables and χ² tests or Fisher exact tests for categorical variables.

Results: Of the 13 946 cases reviewed, 59 patients experienced a postoperative C5 palsy. The incidence rate across the 21 sites ranged from 0% to 2.5%. At most recent follow-up, 32 patients reported complete resolution of symptoms (54.2%), 15 had symptoms resolve with residual effects (25.4%), 10 patients did not recover (17.0%), and 2 were lost to follow-up (3.4%).

Conclusion: C5 palsy occurred in all surgical approaches and across a variety of diagnoses. The majority of patients had full recovery or recovery with residual effects. This study represents the largest series of North American patients reviewed to date.

Keywords: C5 palsy; cervical spine surgery; myelopathy; outcome; postoperative complication.