title: Neurological complications of cervical spine surgery: C5 palsy and intraoperative monitoring.
abstract: METHODS
  Review article.
  
  
  OBJECTIVE
  To review the epidemiology, etiology, risk factors, prevention, and treatment of neurological complications associated with cervical spine surgery. The article focuses on C5 palsy and intraoperative neurophysiological monitoring.
  
  
  BACKGROUND
  Neurological problems are the complications most feared by patients and surgeons alike, but, fortunately, spinal cord injury is uncommon. C5 palsy is a less severe but much more common and perplexing problem. Intraoperative monitoring is widely used in cervical spine surgery, but it is unclear how effective it is at preventing spinal cord or nerve root injury.
  
  
  METHODS
  Narrative and review of the literature.
  
  
  RESULTS
  The incidence of new, severe motor weakness in 2 or more extremities occurring within 12 hours of surgery is 0.18%. The rate in the cervical spine is 3 of 1000. The incidence of isolated C5 palsy is much greater; the rate varies between 0% and 30%, depending on how the condition is defined and which patient group is being analyzed. Numerous theories have been postulated to explain the pathogenesis of C5 palsy, and preventative strategies are discussed. Approximately 70% of patients recover completely without treatment. The mean time to full recovery is 4 to 5 months. Recovery is spontaneous; no treatment has been shown to shorten the time to recovery or improve the recovery rate. A systematic review of the literature found a high level of evidence that multimodal intraoperative monitoring is effective at detecting intraoperative neurological injury. The evidence that intraoperative monitoring reduces the rate of new or worsened perioperative neurological deficits is not as strong. Algorithms help surgeons respond to monitoring alerts and manage neurological deficits that are identified postoperatively.
  
  
  CONCLUSIONS
  The keys to managing neurological complications in cervical spine surgery are prevention through careful planning, appropriate multimodal monitoring, meticulous surgical technique, and decisive action when a problem is identified.
authors.affiliation: Department of Orthopedics, Mayo Clinic, Rochester, MN 55905, USA. currier.brad@mayo.edu
authors.forename: Bradford L
authors.initials: BL
authors.lastname: Currier
mesh_terms: D020516:Brachial Plexus Neuropathies / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control*; D002574:Cervical Vertebrae / Q000473:pathology / Q000601:surgery; D019299:Decompression, Surgical / Q000009:adverse effects / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods / Q000592:standards*; D019635:Neurosurgical Procedures / Q000009:adverse effects* / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control*; D055009:Spondylosis / Q000209:etiology / Q000473:pathology / Q000601:surgery