C5 nerve root palsy following decompression of cervical spine with anterior versus posterior types of procedures in patients with cervical myelopathy

Abstract

C5 palsy is a well-known complication of cervical spine decompression surgery. The complication develops in both posterior and anterior approaches. We aimed to review reports regarding postoperative C5 palsy in hopes for better prevention and treatment of this morbidity. We systematically reviewed and evaluated the abstracts and full texts of the identified papers in the literature. We reviewed and analyzed papers published between January 1970 and February 2015 regarding C5 palsy as a complication of cervical surgical procedures. We made statistical comparisons as much as possible. We did not find any statistical significance between the pathologies (p = 0.088) and between the surgical routes (p = 0.486). There was statistical significance between the types of procedures (p < 0.05). Posterior laminectomy had low incidence of C5 palsy when compared to laminectomy and fusion (p = 0.029) and laminoplasty (p = 0.37). There was no statistically significant difference between anterior cervical decompression and fusion and other procedures (p > 0.05). Some studies conclude that anterior procedure is more safe. Of all anterior procedures, the multilevel ACDF had the lowest incidence of C5 palsy. The hybrid technique can be chosen for more than two-vertebra corpectomy. In term of posterior procedures, laminectomy is safer. To prevent C5 palsy, electromyography can be used as a sensitive predictor and selective foraminotomy can be performed.