Incidence of C5 Palsy and Recovery Rate After Cervical Spine Surgery: A Systematic Review and Meta-Analysis

Authors

Isabelle G. Stockman, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA.
Mohamed A. Soliman, Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA.
Esteban Quiceno, Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA.
Alexander O. Aguirre, Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA.
Mirza Baig, Kansas City University College of Osteopathic Medicine, Kansas City, Missouri, USA.
Ayub Ansari, Kansas City University College of Osteopathic Medicine, Kansas City, Missouri, USA.
Yazan Tanbour, Kansas City University College of Osteopathic Medicine, Kansas City, Missouri, USA.
Amna Aslam, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA.
Hannon W. Levy, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.
Moleca M. Ghannam, Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA.
Cathleen C. Kuo, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA.
Justin Im, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA.
Evan Burns, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA.
Evan M. Sood, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA.
Umar Masood, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA.
Hendrick Francois, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA.
Lauren C. Levy, Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA.
Rehman Baig, Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA.
Asham Khan, Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA.
John Pollina, Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA.
Jeffrey P. Mullin, Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA.

Document Type

Journal Article

Publication Date

9-16-2025

Journal

Neurosurgery

DOI

10.1227/neu.0000000000003704

Keywords

Anterior cervical diskectomy and fusion; C5 palsy; Laminectomy; Laminoplasty; Posterior cervical decompression and fusion; Postoperative complications; Recovery

Abstract

BACKGROUND AND OBJECTIVES: C5 nerve palsy is a debilitating complication of cervical spine surgery that can occur after certain approaches. To our knowledge, no previous systematic reviews have compared the rates of C5 nerve palsy after different cervical approaches, identifying the rate at which this complication becomes permanent. We aimed to compare the rates of C5 palsy after different cervical spine surgery approaches and the rates of recovery when C5 palsy was present. METHODS: A literature search of the PubMed and Embase databases from their inception to July 1, 2023, was completed to identify studies that focused on cervical spine surgery. Studies were excluded if they did not provide the rate of C5 palsy occurrence or define which surgical approaches were used. A pooled, weighted prevalence rate of C5 palsy was calculated for each approach, including the rate of permanent C5 palsy. RESULTS: A total of 155 studies met the inclusion criteria. Of these studies, 22 (14.2%) reported on laminectomies, 77 (49.7%) on laminoplasties, 38 (24.5%) on posterior cervical decompression and fusion, 39 (25.2%) on anterior cervical diskectomy and fusion, and 4 (2.6%) on corpectomies. Patients who had laminectomies had the highest incidence of C5 palsy at a pooled rate of 8%, of which 1.44% of cases were permanent. This was followed by posterior cervical decompression and fusion with a rate of 7.03% and a permanence rate of 1.02%. Patients receiving laminoplasties had a C5 palsy incidence of 5.11%; of these, 0.28% of cases were permanent. Patients who had corpectomies had an incidence of 4.16%; those who had anterior cervical diskectomy and fusions had the lowest incidence of 2.61%, of which 1.06% of cases were permanent. CONCLUSION: C5 nerve palsy is a known complication after cervical spine surgeries, with increased rates in posterior approaches, although the rate of these complications becoming permanent is minimal.

APA Citation

Stockman, Isabelle G.; Soliman, Mohamed A.; Quiceno, Esteban; Aguirre, Alexander O.; Baig, Mirza; Ansari, Ayub; Tanbour, Yazan; Aslam, Amna; Levy, Hannon W.; Ghannam, Moleca M.; Kuo, Cathleen C.; Im, Justin; Burns, Evan; Sood, Evan M.; Masood, Umar; Francois, Hendrick; Levy, Lauren C.; Baig, Rehman; Khan, Asham; Pollina, John; and Mullin, Jeffrey P., "Incidence of C5 Palsy and Recovery Rate After Cervical Spine Surgery: A Systematic Review and Meta-Analysis" (2025). GW Authored Works. Paper 7944.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/7944

Department

School of Medicine and Health Sciences Student Works