Characterizing the Incidence and Management of Rotator Cuff Injuries in Patients with Postoperative C5 Palsy...

To determine the incidence of postoperative shoulder injuries and subsequent interventions in patients with C5 palsy and to inform clinical management and prevent injury following cervical spine surgery.

A retrospective review of medical records of patients who underwent cervical fusion between 2016 and 2024 at a tertiary academic hospital was performed. Patients with postoperative C5 palsy and/or deltoid weakness were identified via auto extraction to identify shoulder dysfunction or pathologies requiring orthopedic intervention due to postoperative C5 palsy.

Of decompression and fusion procedures reviewed, 72 cases (4%) were complicated by new-onset postoperative C5 palsy and/or deltoid weakness, with a median onset of 5 days postsurgery. More decompressed levels were correlated with earlier C5 palsy onset (P = 0.039), but not the number of fused levels. Additional symptoms included upper extremity paresthesia (56%) and axial neck pain (40%). Shoulder imaging was performed in 21% cases. Among patients with C5 palsy, 11% required orthopedic interventions, occurring on average about 1 year after onset. Further intervention was not significantly associated with decompression or fusion levels but was linked to combined symptoms of sensory symptoms and weakness (P = 0.049). Only 25% experienced complete symptom resolution after intervention, and no cases saw full resolution of C5 palsy.

C5 palsy occurred in 4% of surgeries, consistent with existing literature. Increased laminectomy levels correlated with faster onset of C5 palsy, and persistent C5 palsy increased the risk for additional shoulder interventions with limited symptom resolution, underscoring the importance of early diagnosis and management.