Factors Associated With C5 Palsy Following Cervical Spine Surgery: A Systematic Review

Area of Science:

• Neurosurgery
• Orthopedics
• Spinal Surgery

Background:

• C5 palsy (C5P) is a disabling postoperative complication with a wide reported incidence.
• The exact causation and prevention of C5P remain controversial, with potential multifactorial pathophysiology.
• Foraminal nerve root tethering is one proposed explanation for C5P occurrence.

Purpose of the Study:

• To systematically review risk factors for C5P with narrow inclusion criteria.
• To elucidate risk factors for C5P related to a common pathophysiological mechanism.
• To address the ambiguity surrounding C5P causation and prevention.

Main Methods:

• Systematic review of electronic databases and article references.
• Inclusion of studies investigating demographic, clinical, surgical, and radiographic factors.
• Meta-analysis of 16 selected studies (out of 122 initially screened).

Main Results:

• The pooled prevalence of C5P was 6.0% (range: 4.2%-24.1%).
• No consistent association found between C5P and demographic, clinical, or specific surgical factors.
• Decreased foraminal diameter and preoperative cord rotation were identified as significant radiographic risk factors.

Conclusions:

• Ambiguity regarding C5P risk factors persists due to multifactorial pathophysiology and study heterogeneity.
• Foraminal diameter and cord rotation are associated with postoperative C5P.
• Factors contributing to foraminal stenosis may synergistically increase the risk of C5P.