Resident SUNY Upstate Syracuse, New York, United States
Introduction: Cervical spine surgeries can be complicated by post-operative onset of C5 palsy. This is commonly defined as a new deterioration of at least 1 level of muscle strength of the deltoid, and/or the bicep muscle using the manual muscle testing scale.
Methods: A comprehensive literature review using PRISMA guidelines was performed evaluated C5 palsy rates and the use of prophylactic foraminotomies during posterior cervical decompressions (including laminectomy, laminoplasty, or decompression and fusion). Data was separated into two groups: posterior cervical decompression with prophylactic foraminotomy (F+), or without foraminotomy (F-), and then C5 palsy rates were compared between the two groups. Secondary analysis was conducted using only patients who underwent laminoplasty with or without prophylactic foraminotomy.
Results: The F+ group included 8 studies with 427 patients and had a C5 palsy rate of 7.9%. The F- group included 20 studies with 4353 patients and had a C5 palsy rate of 5.4%. The incidence rate ratio was 1.46 with a 95% CI of 0.99-2.10 and a P-value of <.046. When laminectomy data was excluded, the F+ group had 5 studies with 302 patients with a C5 palsy rate of 1.99%; the F- group had 11 studies with 3182 patients with a C5 palsy rate of 3.77%. The incidence rate ratio for the secondary analysis was .527 with a 95% CI of 0.19-1.18 and a P-value of <.106.
Conclusion : These results suggest performing a prophylactic C5 foraminotomy during a posterior cervical decompression increases the rate of C5 palsy post-operatively. When isolated to evaluating only laminoplasties, a prophylactic C5 foraminotomy had no statistical impact on C5 palsy rates. Use of preoperative studies and clinical assessment for judicious use of C5 foraminotomies in select patients may result in the best patient outcomes.
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