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Neurological Rehabilitation

(Kiosk 3) An Unusual Case of Bilateral C5 Nerve Root Palsy Following Cervical Decompression and Fusion: A Case Report

Friday, November 17, 2023
8:00 AM – 9:15 AM CT

    Primary Author(s)

  • Thomas Li, DO

    Resident Physician
    Stony Brook Medicine/University Hospital PM&R Program
    Great Neck, New York

    • Co-Author(s)

  • KZ

    Karolina Zektser, DO

    Resident physician
    Stony Brook Medicine/University Hospital PM&R Program
    Port Jefferson, New York

  • LB

    Lauren Bartels, DO

    Resident Physician
    Stony Brook Medicine/University Hospital PM&R Program
    Port Jefferson, New York

  • PS

    Pawandeep Singh, DO

    Resident Physician
    Stony Brook Medicine/University Hospital PM&R Program
    Port Jefferson, New York

  • YL

    Yu-Jen Lai, MD

    Attending Physician
    n/a
    Port Jefferson, New York

Case Diagnosis: 75 year old female with bilateral C5 palsy status-post C2-C7 posterior fusion laminectomy and facetectomy

Case Description or Program Description: The patient was admitted to the rehabilitation unit from a tertiary care hospital after undergoing C2-C7 posterior fusion laminectomy and facetectomy for cervical stenosis one month prior. Patient reportedly had numbness and tingling in her right arm before surgery, but no discernable weakness. On post-op day #2, patient experienced weakness in bilateral arms, R>L, and was given dexamethasone. Two CT scans of the cervical spine demonstrated no acute findings and intact hardware. Her exam was notable for significant muscle atrophy of deltoid and biceps muscles, with her right upper extremity more severely affected. Patient’s strength grades were as follows: 0/5 right shoulder abduction, 2/5 right elbow flexion, 3/5 left shoulder abduction and 3/5 left elbow flexion.

Setting: Rehabilitation Unit

Assessment/Results: At one month post-surgery, the patient has significant limitations in bilateral arm strength from C5 palsy. Patient is able to tolerate upper extremity exercises while in therapy, and developments in her progress are still ongoing.

Discussion (relevance): C5 palsy is a rare post-operative condition (incidence varies from < 1% to 29%) that either results from direct injury, reperfusion injury, or traction injury resulting from shifting of the spinal cord. The overall incidence of bilateral C5 palsy is 0.9%. Excessive spinal cord shifting, intervertebral foraminal stenosis, ossified posterior longitudinal ligament, and male gender are thought to be risk factors. Given the importance of C5-innervated muscles for activities of daily living, these patients have a severely affected quality of life. Many patients undergo early rehabilitation with the goal of restoring strength and function. Fortunately, this condition has a good prognosis, and many patients tend to recover within 6 months to 1 year.

Conclusions: Bilateral C5 palsy is a rare complication of cervical spine decompression that can have severe consequences on quality of life. Early recognition and rehabilitation is thus important for regaining strength and function of the upper extremities.