Medical Student Rothman Orthopaedic Institute at Thomas Jefferson University Rothman Orthopaedic Institute
Disclosure(s):
Rachel Huang, BA: No financial relationships to disclose
Introduction: C5 palsy is a common and debilitating complication following cervical spine surgery with a prognosis that can be difficult to predict. No prior studies have examined risk factors predictive of timing of C5 palsy recovery. The purpose of this study is to assess the impact of demographic and surgical factors on postoperative C5 palsy recovery timing.
Methods: Adult patients with C5 palsy after either anterior or posterior cervical discectomy and fusion (ACDF, PCDF, respectively) were identified (2010-2023). Patient demographics and surgical variables were recorded. Patients were divided by resolution to preoperative strength at six months and one year after surgery. Appropriate statistical analysis was performed with alpha < 0.05.
Results: 94 patients had postoperative C5 palsy after PCDF: 63 (67.0%), ACDF: 22 (23.4%), ACDF/PCDF: 6 (6.4%), and laminoplasty: 3 (3.2%). Patients resolved by 6 months were more likely to be younger (60.1 ± 12.4 vs. 66.0 ± 10.4; p=0.009), female (44.7% vs 19.2%; p=0.018), have a lower CCI (2.76 ± 2.10 vs. 3.40 ± 1.60; p=0.032), and have higher deltoid (3.03 ± 1.1 vs. 1.79 ± 1.13; p< 0.001) and biceps (4 ± 0.93 vs. 2.96 ± 1.12; p< 0.001) strength at diagnosis. Biceps involvement was associated with failure to recover at six months (42 (80.8%) vs. 21 (55.3%); p=0.018). Similar factors were associated with recovery at one year after surgery. Procedure type was not found to be independently predictive of recovery timing after controlling for levels fused. 71% of all patients recovered within one year.
Conclusion : Earlier C5 palsy recovery was associated with being younger, female, and having higher muscle strength at diagnosis. Patients with biceps involvement recovered slower. Procedure type was independently predictive for timing of recovery, controlling for levels fused. Identifying these risk factors can enhance patient counseling.