From the Research
The workup for postoperative C5 palsy after posterior cervical spine decompression should begin with immediate neurological assessment to document the extent of the deficit, typically manifesting as deltoid and/or biceps weakness. Obtain urgent cervical spine MRI to rule out hematoma, inadequate decompression, or new compression, as suggested by 1. Electromyography (EMG) and nerve conduction studies should be performed 3-4 weeks after onset to confirm the diagnosis and assess severity. Laboratory tests including complete blood count, inflammatory markers, and electrolytes help exclude systemic causes. Management typically involves physical therapy focusing on range of motion and strengthening exercises, starting with 3-5 sessions weekly for 6-8 weeks. Pain control with NSAIDs like ibuprofen 400-600mg every 6 hours or acetaminophen 500-1000mg every 6 hours may be needed. Most cases resolve spontaneously within 3-6 months with conservative management. C5 palsy occurs in 4-11% of posterior cervical decompressions due to nerve root tethering during cord shift, direct nerve injury, or reperfusion injury to the nerve root, as reported by 2. Close monitoring with follow-up neurological examinations at 2 weeks, 6 weeks, 3 months, and 6 months post-diagnosis is recommended to track recovery progress. Risk factors for C5 palsy include ossification of the posterior longitudinal ligament, narrower intervertebral foramen, laminectomy, excessive spinal cord drift, and male gender, as identified by 3. Preventive measures such as foraminotomy and intraoperative neuromonitoring may be considered, especially in high-risk patients, as suggested by 4 and 2. Overall, a comprehensive approach to diagnosis and management is crucial to optimize outcomes in patients with postoperative C5 palsy.