Post-Operative C5 Root Palsy and the Use of Neurophysiologic Monitoring

Steven Mark Spitz, MD1, Amjad Anaizi, MD1, Faheem Sandhu, MD, PhD1

1Washington, DC United States

Keywords: outcome, nerve root, spine surgery, neurophysiological monitoring, spinal cord injury

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     The C5 nerve root is particularly vulnerable to injury during cervical spine surgery.
     We present a series of patients that underwent cervical decompressive procedures for myelopathy and/or radiculopathy and review incidence of C5 palsy and any associated changes in intra-operative neurophysiologic monitoring.
     All patients in this series presented with symptoms of myelopathy and/or radiculopathy with imaging evidence of either cervical spinal cord or nerve root compression. Anterior discectomy and fusion (ADF) was performed in 427 patients, anterior corpectomy and fusion (ACF) in 72 patients, and laminectomy in 101 patients.
     Retrospective data was reviewed in 600 patients undergoing cervical procedures.  All patients were assessed with manual motor testing pre and post-operatively.
     Postoperative C5 root palsy occurred in 5 cases (0.8%). No cases (0.0%) were seen with ADF, 2 cases (2.7%) were ACF, and 3 cases (3.0%) were laminectomies. In all cases, there were no changes in intra-operative neurophysiologic monitoring to suggest either spinal cord or nerve root injury secondary to operative manipulation. In addition, no patient presented with C5 root palsy before post-operative day 2.
     This is a retrospective study.
     This study demonstrates that patients undergoing cervical decompression for cervical myelopathy and/or radiculopathy remain at risk for C5 root palsy irrespective of normal intra-operative neurophysiologic monitoring.
     Given that all patients in this study experienced a delayed onset of C5 palsy, MEP, SSEP, and EMG may not be sensitive enough monitoring techniques to assess the risk of postoperative C5 root palsy.


Project Roles:

S. Spitz (), A. Anaizi (), F. Sandhu ()