Postoperative C5 Palsy Following Posterior Cervical Decompression and Fusion: A Case Report

Posterior cervical decompression and fusion (PCDF) is a well-established surgical procedure for the management of multilevel cervical spinal cord compression. Although generally safe, postoperative C5 palsy is a recognized complication that can significantly affect functional recovery.

We report the case of a patient with multilevel cervical compressive myelopathy who underwent posterior cervical decompression and fusion. The immediate postoperative period was complicated by new-onset weakness of shoulder abduction and elbow flexion, consistent with C5 palsy. Postoperative imaging confirmed satisfactory decompression and appropriate implant positioning, with no evidence of hematoma or hardware-related complications. The patient was managed conservatively with close neurological monitoring and a structured rehabilitation program.

The exact mechanism of postoperative C5 palsy remains unclear, with proposed causes including posterior shift of the spinal cord, nerve root traction, ischemia, and reperfusion injury. Early recognition, exclusion of compressive causes, and rehabilitation are essential for optimal recovery.

C5 palsy is an uncommon but important complication following PCDF. Prompt diagnosis, appropriate imaging, and multidisciplinary rehabilitation are crucial to maximize neurological recovery and improve functional outcomes.

Neurology, Neurosurgery, Orthopedics.