Incidence and Management of Rotator Cuff Injuries in Patients with Postoperative C5 Palsy Following Cervical Spine Surgery

Introduction: Postoperative C5 palsy is a potential complication following cervical spine surgery that most commonly presents as difficulty with shoulder abduction. Motor weakness occurs primarily as a result of deltoid weakness, though other muscles of the upper extremities including rotator cuff muscles can be affected as well. Consequently, patients with C5 palsy may be at an increased risk of further developing rotator cuff injuries. This study aims to evaluate the incidence of rotator cuff injuries and subsequent shoulder interventions in patients who suffered postoperative C5 palsy.

Methods: A total of 1,746 patients from a tertiary academic hospital who underwent either posterior or anterior cervical fusion between 2016-2024 were identified by retrospective review. Patients with postoperative “C5 palsy” and/or “deltoid weakness” as delineated in their medical records were collected to identify those who subsequently experienced shoulder dysfunction or shoulder-related pathologies requiring further orthopedic intervention such as rotator cuff surgery, steroid injections, or immobilization as a result of their postoperative C5 palsy.

Results: A total of 56 fusions (3.2%) were complicated by new C5 nerve palsy and/or deltoid weakness. The average age of patients with C5 palsy was 66.0 years (+/- 10.0), and 41 patients (73.2%) were male. Forty-six (82.1%) of these cases were performed via a posterior approach. Of the cases with C5 palsy, 5 (8.9%) underwent subsequent intervention for palsy-related shoulder complications an average of 1.7 years (+/- 2.6) postoperatively. Interventions included: 3 steroid injections, 1 shoulder arthroplasty, and 1 immobilization. All cases requiring shoulder intervention had a posterior fusion, including 2 revision surgeries.

Conclusion : While our rate of postoperative C5 palsy is consistent with current literature, we also characterize incidence the subsequent development of rotator-cuff injury in these patients. As most interventions occurred more than 1-year postoperatively, these findings may help guide early management and referrals to reduce progression of C5 palsy-related rotator-cuff injury.