From the Research
C5 palsy is a neurological complication that occurs in approximately 5-10% of patients following cervical spine surgery, and the most recent and highest quality study suggests that treatment includes physical therapy, pain management, and in some cases, nerve transfers, with the goal of improving morbidity, mortality, and quality of life outcomes. The condition typically develops within the first week after surgery, though it can appear immediately or be delayed up to two weeks postoperatively. Most cases of C5 palsy are temporary and resolve spontaneously within 3-6 months with conservative management. Some key points to consider in the management of C5 palsy include:
- The use of electromyography to predict likelihood of recovery, with studies showing that electrodiagnostic testing performed 6-weeks to 6-months postinjury can help identify patients likely to experience complete recovery 1
- The importance of early referral to peripheral nerve specialists, with a study suggesting that patients with abnormal electrophysiology results are most likely to receive multimodal treatment, and that early (6-week to 6-month) electrophysiology data may help to ensure that patients likely to benefit from nerve transfer procedures are referred to a specialist within the 9-12-month time frame associated with the best recovery of function 2
- The role of nerve transfers in the treatment of C5 palsy, with a study showing that consensus exists among peripheral nerve surgeons on the use of nerve transfers for surgical treatment in cases with severe motor weakness failing to improve, and that the transfer of the ulnar nerve to the musculocutaneous nerve is the most common choice 3
- The need for patients to be counseled about this potential complication before cervical spine surgery and reassured about its generally favorable prognosis, with a study highlighting the importance of patient education and counseling in the management of C5 palsy 4.