Research progress of etiologies for C<sub>5</sub> palsy after cervical decompression_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

GUO Chuan ^1,2 , SONG Xinyue ¹ ,  KONG Qingquan ² , WANG Yu ² , WU Ye ^1,2 , LI Weilong ^1,2

1. West China School of Medicine, Sichuan University, Chengdu Sichuan, 610041, P. R. China;
2. Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China;

Corresponding author：

KONG Qingquan, Email: hxkongqqspine@163.com

Keywords：

Cervical decompression; C₅ palsy; nerve root; spinal cord

DOI：

10.7507/1002-1892.202111072

Video：

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Objective To review the definition and possible etiologies for C₅ palsy. Methods The literature on C₅ palsy at home and abroad in recent years was extensively reviewed, and the possible etiologies were analyzed based on clinical practice experience. Results There are two main theories (nerve root tether and spinal cord injury) accounting for the occurrence of C₅ palsy, but both have certain limitations. The former can not explain the occurrence of C₅ palsy after anterior cervical spine surgery, and the latter can not explain that the clinical symptoms of C₅ palsy is often the motor dysfunction of the upper limb muscles. Based on the previous reports, combining our clinical experience and research, we propose that the occurrence of C₅ palsy is mainly due to the instrumental injury of anterior horn of cervical spinal cord during anterior cervical decompression. In addition, the C₅ palsy following surgery via posterior approach may be related to the nerve root tether caused by the spinal cord drift after decompression. Conclusion In view of the main cause of C₅ palsy after cervical decompression, it is recommended to reduce the compression of the spinal cord by surgical instruments to reduce the risk of this complication.

Citation： GUO Chuan, SONG Xinyue, KONG Qingquan, WANG Yu, WU Ye, LI Weilong. Research progress of etiologies for C₅ palsy after cervical decompression. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(3): 376-379. doi: 10.7507/1002-1892.202111072 Copy

1.	Pennington Z, Lubelski D, Westbroek EM, et al. Spinal cord float back is not an independent predictor of postoperative C₅ palsy in patients undergoing posterior cervical decompression. Spine J, 2020, 20(2): 266-275.
2.	Machino M, Yukawa Y, Hida T, et al. Modified double-door laminoplasty in managing multilevel cervical spondylotic myelopathy: surgical outcome in 520 patients and technique description. J Spinal Disord Tech, 2013, 26(3): 135-140.
3.	Nakashima H, Imagama S, Yukawa Y, et al. Multivariate analysis of C-5 palsy incidence after cervical posterior fusion with instrumentation. J Neurosurg Spine, 2012, 17(2): 103-110.
4.	Yoshihara H, Margalit A, Yoneoka D. Incidence of C₅ palsy: Meta-analysis and potential etiology. World Neurosurg, 2019, 122: e828-e837.
5.	Liu B, Chu Y, Ma J, et al. Analysis of risk factors for C₅ nerve root paralysis after posterior cervical decompression. BMC Musculoskelet Disord, 2021, 22(1): 614. doi: 10.1186/s12891-021-04434-y.
6.	Hitchon PW, Moritani T, Woodroffe RW, et al. C₅ palsy following posterior decompression and instrumentation in cervical stenosis: Single center experience and review. Clin Neurol Neurosurg, 2018, 174: 29-35.
7.	Dombrowski ME, Morales-Restrepo A, Fourman MS, et al. Prophylactic perioperative dexamethasone decreases the incidence of postoperative C₅ palsies after a posterior cervical laminectomy and fusion. Spine J, 2019, 19(2): 253-260.
8.	Scoville WB. Cervical spondylosis treated by bilateral facetectomy and laminectomy. J Neurosurg, 1961, 18: 423-428.
9.	Keegan JJ. The cause of dissociated motor loss in the upper extremity with cervical spondylosis. J Neurosurg, 1965, 23(5): 528-536.
10.	Zhao X, Xue Y, Pan F, et al. Extensive laminectomy for the treatment of ossification of the posterior longitudinal ligament in the cervical spine. Arch Orthop Trauma Surg, 2012, 132(2): 203-209.
11.	Wang T, Wang H, Liu S, et al. Incidence of C₅ nerve root palsy after cervical surgery: A meta-analysis for last decade. Medicine (Baltimore), 2017, 96(45): e8560. doi: 10.1097/MD.0000000000008560.
12.	Sakaura H, Hosono N, Mukai Y, et al. C₅ palsy after decompression surgery for cervical myelopathy: review of the literature. Spine (Phila Pa 1976), 2003, 28(21): 2447-2451.
13.	Oh JK, Hong JT, Kang DH, et al. Epidemiology of C₅ palsy after cervical spine surgery: A 21-center study. Neurospine, 2019, 16(3): 558-562.
14.	Zhang H, Lu S, Sun T, et al. Effect of lamina open angles in expansion open-door laminoplasty on the clinical results in treating cervical spondylotic myelopathy. J Spinal Disord Tech, 2015, 28(3): 89-94.
15.	Currier BL. Neurological complications of cervical spine surgery: C₅ palsy and intraoperative monitoring. Spine (Phila Pa 1976), 2012, 37(5): E328-E334.
16.	Traynelis VC, Malone HR, Smith ZA, et al. Rare complications of cervical spine surgery: Horner’s syndrome. Global Spine J, 2017, 7(1 Suppl): 103S-108S.
17.	Kim S, Lee SH, Kim ES, et al. Clinical and radiographic analysis of C5 palsy after anterior cervical decompression and fusion for cervical degenerative disease. J Spinal Disord Tech, 2014, 27(8): 436-441.
18.	Baba S, Ikuta K, Ikeuchi H, et al. Risk factor analysis for C₅ palsy after double-door laminoplasty for cervical spondylotic myelopathy. Asian Spine J, 2016, 10(2): 298-308.
19.	Tsuji T, Matsumoto M, Nakamura M, et al. Factors associated with postoperative C₅ palsy after expansive open-door laminoplasty: retrospective cohort study using multivariable analysis. Eur Spine J, 2017, 26(9): 2410-2416.
20.	Radcliff KE, Limthongkul W, Kepler CK, et al. Cervical laminectomy width and spinal cord drift are risk factors for postoperative C₅ palsy. J Spinal Disord Tech, 2014, 27(2): 86-92.
21.	Eskander MS, Balsis SM, Balinger C, et al. The association between preoperative spinal cord rotation and postoperative C₅ nerve palsy. J Bone Joint Surg (Am), 2012, 94(17): 1605-1609.
22.	Kaneyama S, Sumi M, Kanatani T, et al. Prospective study and multivariate analysis of the incidence of C₅ palsy after cervical laminoplasty. Spine (Phila Pa 1976), 2010, 35(26): E1553-E1558.
23.	Greiner-Perth R, Elsaghir H, Böhm H, et al. The incidence of C₅-C₆ radiculopathy as a complication of extensive cervical decompression: own results and review of literature. Neurosurg Rev, 2005, 28(2): 137-142.
24.	Hasegawa K, Homma T, Chiba Y. Upper extremity palsy following cervical decompression surgery results from a transient spinal cord lesion. Spine (Phila Pa 1976), 2007, 32(6): E197-E202.
25.	Chiba K, Toyama Y, Matsumoto M, et al. Segmental motor paralysis after expansive open-door laminoplasty. Spine (Phila Pa 1976), 2002, 27(19): 2108-2115.
26.	Ikegami S, Tsutsumimoto T, Ohta H, et al. Preoperative spinal cord damage affects the characteristics and prognosis of segmental motor paralysis after cervical decompression surgery. Spine (Phila Pa 1976), 2014, 39(6): 463-468.
27.	Tsuzuki N, Abe R, Saiki K, et al. Paralysis of the arm after posterior decompression of the cervical spinal cord. Ⅱ. Analyses of clinical findings. Eur Spine J, 1993, 2(4): 197-202.

1. Pennington Z, Lubelski D, Westbroek EM, et al. Spinal cord float back is not an independent predictor of postoperative C₅ palsy in patients undergoing posterior cervical decompression. Spine J, 2020, 20(2): 266-275.
2. Machino M, Yukawa Y, Hida T, et al. Modified double-door laminoplasty in managing multilevel cervical spondylotic myelopathy: surgical outcome in 520 patients and technique description. J Spinal Disord Tech, 2013, 26(3): 135-140.
3. Nakashima H, Imagama S, Yukawa Y, et al. Multivariate analysis of C-5 palsy incidence after cervical posterior fusion with instrumentation. J Neurosurg Spine, 2012, 17(2): 103-110.
4. Yoshihara H, Margalit A, Yoneoka D. Incidence of C₅ palsy: Meta-analysis and potential etiology. World Neurosurg, 2019, 122: e828-e837.
5. Liu B, Chu Y, Ma J, et al. Analysis of risk factors for C₅ nerve root paralysis after posterior cervical decompression. BMC Musculoskelet Disord, 2021, 22(1): 614. doi: 10.1186/s12891-021-04434-y.
6. Hitchon PW, Moritani T, Woodroffe RW, et al. C₅ palsy following posterior decompression and instrumentation in cervical stenosis: Single center experience and review. Clin Neurol Neurosurg, 2018, 174: 29-35.
7. Dombrowski ME, Morales-Restrepo A, Fourman MS, et al. Prophylactic perioperative dexamethasone decreases the incidence of postoperative C₅ palsies after a posterior cervical laminectomy and fusion. Spine J, 2019, 19(2): 253-260.
8. Scoville WB. Cervical spondylosis treated by bilateral facetectomy and laminectomy. J Neurosurg, 1961, 18: 423-428.
9. Keegan JJ. The cause of dissociated motor loss in the upper extremity with cervical spondylosis. J Neurosurg, 1965, 23(5): 528-536.
10. Zhao X, Xue Y, Pan F, et al. Extensive laminectomy for the treatment of ossification of the posterior longitudinal ligament in the cervical spine. Arch Orthop Trauma Surg, 2012, 132(2): 203-209.
11. Wang T, Wang H, Liu S, et al. Incidence of C₅ nerve root palsy after cervical surgery: A meta-analysis for last decade. Medicine (Baltimore), 2017, 96(45): e8560. doi: 10.1097/MD.0000000000008560.
12. Sakaura H, Hosono N, Mukai Y, et al. C₅ palsy after decompression surgery for cervical myelopathy: review of the literature. Spine (Phila Pa 1976), 2003, 28(21): 2447-2451.
13. Oh JK, Hong JT, Kang DH, et al. Epidemiology of C₅ palsy after cervical spine surgery: A 21-center study. Neurospine, 2019, 16(3): 558-562.
14. Zhang H, Lu S, Sun T, et al. Effect of lamina open angles in expansion open-door laminoplasty on the clinical results in treating cervical spondylotic myelopathy. J Spinal Disord Tech, 2015, 28(3): 89-94.
15. Currier BL. Neurological complications of cervical spine surgery: C₅ palsy and intraoperative monitoring. Spine (Phila Pa 1976), 2012, 37(5): E328-E334.
16. Traynelis VC, Malone HR, Smith ZA, et al. Rare complications of cervical spine surgery: Horner’s syndrome. Global Spine J, 2017, 7(1 Suppl): 103S-108S.
17. Kim S, Lee SH, Kim ES, et al. Clinical and radiographic analysis of C5 palsy after anterior cervical decompression and fusion for cervical degenerative disease. J Spinal Disord Tech, 2014, 27(8): 436-441.
18. Baba S, Ikuta K, Ikeuchi H, et al. Risk factor analysis for C₅ palsy after double-door laminoplasty for cervical spondylotic myelopathy. Asian Spine J, 2016, 10(2): 298-308.
19. Tsuji T, Matsumoto M, Nakamura M, et al. Factors associated with postoperative C₅ palsy after expansive open-door laminoplasty: retrospective cohort study using multivariable analysis. Eur Spine J, 2017, 26(9): 2410-2416.
20. Radcliff KE, Limthongkul W, Kepler CK, et al. Cervical laminectomy width and spinal cord drift are risk factors for postoperative C₅ palsy. J Spinal Disord Tech, 2014, 27(2): 86-92.
21. Eskander MS, Balsis SM, Balinger C, et al. The association between preoperative spinal cord rotation and postoperative C₅ nerve palsy. J Bone Joint Surg (Am), 2012, 94(17): 1605-1609.
22. Kaneyama S, Sumi M, Kanatani T, et al. Prospective study and multivariate analysis of the incidence of C₅ palsy after cervical laminoplasty. Spine (Phila Pa 1976), 2010, 35(26): E1553-E1558.
23. Greiner-Perth R, Elsaghir H, Böhm H, et al. The incidence of C₅-C₆ radiculopathy as a complication of extensive cervical decompression: own results and review of literature. Neurosurg Rev, 2005, 28(2): 137-142.
24. Hasegawa K, Homma T, Chiba Y. Upper extremity palsy following cervical decompression surgery results from a transient spinal cord lesion. Spine (Phila Pa 1976), 2007, 32(6): E197-E202.
25. Chiba K, Toyama Y, Matsumoto M, et al. Segmental motor paralysis after expansive open-door laminoplasty. Spine (Phila Pa 1976), 2002, 27(19): 2108-2115.
26. Ikegami S, Tsutsumimoto T, Ohta H, et al. Preoperative spinal cord damage affects the characteristics and prognosis of segmental motor paralysis after cervical decompression surgery. Spine (Phila Pa 1976), 2014, 39(6): 463-468.
27. Tsuzuki N, Abe R, Saiki K, et al. Paralysis of the arm after posterior decompression of the cervical spinal cord. Ⅱ. Analyses of clinical findings. Eur Spine J, 1993, 2(4): 197-202.

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Research progress of etiologies for C₅ palsy after cervical decompression