Delayed postoperative C5 root palsy and the use of neurophysiologic monitoring

Although advances have been made in surgical technique and intraoperative monitoring, the rate of postoperative C5 palsy remains the same. We attempt to define characteristics which may predict risk of developing postoperative C5 palsy.

Retrospective chart review identified 644 patients undergoing cervical procedures. Anterior cervical discectomy and fusion was performed in 456, anterior cervical corpectomy and fusion (ACCF) in 78, posterior laminectomy and fusion (PLF) in 106, and posterior open-door laminoplasty in 4 patients. All patients had neurophysiologic monitoring [somatosensory-evoked potentials (SSEP), spontaneous electromyogram (EMG), and/or motor-evoked potential (MEP)].

Postoperative C5 root palsy occurred in 5 (2 with ACCF and 3 with PLF) cases (1.4%). In all cases, there were no changes in intraoperative neurophysiologic monitoring. C5 palsy did not occur before postoperative day 2.

Patients undergoing cervical decompression remain at risk for C5 root palsy despite use of monitoring. Given that all patients experienced delayed onset of C5 palsy, MEP, SSEP, and EMG may not be sensitive enough to assess the risk of developing C5 palsy.