Prevalence of C5 nerve root palsy after cervical decompressive surgery: a meta-analysis

To investigate the epidemiological prevalence of C5 palsy in patients following cervical decompressive surgery.

We searched the PUBMED database for relevant studies that mentioned the incidence of C5 palsy after cervical surgery. We also manually screened reference lists for additional qualified articles. Relevant prevalence estimates were calculated by an appropriate meta-analysis. Subgroup analysis, sensitivity analysis, and publication bias assessment were also performed, respectively.

Finally, a total of 79 studies, with 704 C5 palsy cases in 13,621 patients, were included in our meta-analysis. The overall pooled prevalence of C5 palsy was 5.3% (95% CI 4.6-6.0%). Individuals after posterior cervical surgery (5.8%) had a slightly higher prevalence than those after anterior surgery (5.2%), and a similar trend was observed between ossification of posterior longitudinal ligament (OPLL) (5.8%) and cervical spondylotic myelopathy (CSM) (4.5%). The highest prevalence (11.0%) was found in patients who underwent laminectomy and fusion (LIF), while those who received anterior cervical discectomy and fusion (ACDF) had the lowest prevalence (3.3%). Other intermediate prevalence estimates increased gradually, from cervical laminoplasty-only (CLP-only) (5.1%), to CLP plus other posterior procedures (6.5%) and anterior cervical corpectomy and fusion (ACCF) (7.5%). The prevalence was significantly higher in male (5.2%) than in female (2.2%) patients. In most cases, C5 palsy was unilateral and transient, and diagnosed within 3 days (3.4%).

Cervical surgery is associated with high risk of C5 palsy, particularly in patients who received LIF and in male patients. These figures may be useful in the estimation of the probability of C5 palsy following cervical surgery.