Intraoperative Blood Pressure Variability Is Associated With Postoperative C5 Palsy in Elective Cervical Spine...

This was a retrospective single-center study.

To investigate the relationship between intraoperative arterial blood pressure (MAP) changes and the occurrence of C5 palsy.

C5 palsy is a disabling complication of cervical spine surgery, and its pathophysiology remains unknown. We hypothesized that intraoperative MAP changes might influence the occurrence of postoperative C5 palsy.

This retrospective study included patients who underwent continuous arterial blood pressure monitoring during elective cervical spine surgery. Patients were divided into 2 groups according to the presence or absence of C5 palsy (defined as a decrease of at least 1 grade in deltoid muscle strength). The demographics, diagnoses, surgical characteristics, and intraoperative MAP parameters were reviewed.

A total of 74 patients were included in this analysis (mean age: 70.5 y; 22 women). Of these patients, 13 developed C5 palsy, which occurred after a mean of 2.2 days following surgery. There were no significant differences between the C5 palsy and control groups in terms of age, sex, diagnosis, preexisting hypertension, and blood pressure on the day before surgery. Patients with C5 palsy showed a greater change in intraoperative MAP than those in the control group (92​​​​​​ vs. 73 mm Hg, P=0.013). The number of episodes of intraoperative hypotension was similar in the C5 palsy and control groups (2.5 vs. 3.1 episodes). After adjustment by a multivariable logistic regression analysis, intraoperative MAP change remained an independent risk factor for C5 palsy (odds ratio 1.03 per 1 mm Hg increase, 95% CI: 1.01-1.05, P=0.03).

A larger change in the intraoperative MAP was associated with C5 palsy after cervical surgery. Our findings suggest a potential role for intraoperative hemodynamic changes in the development of C5 palsy.