title: Delayed postoperative C5 root palsy and the use of neurophysiologic monitoring.
abstract: BACKGROUND
  Although advances have been made in surgical technique and intraoperative monitoring, the rate of postoperative C5 palsy remains the same. We attempt to define characteristics which may predict risk of developing postoperative C5 palsy.
  
  
  METHODS
  Retrospective chart review identified 644 patients undergoing cervical procedures. Anterior cervical discectomy and fusion was performed in 456, anterior cervical corpectomy and fusion (ACCF) in 78, posterior laminectomy and fusion (PLF) in 106, and posterior open-door laminoplasty in 4 patients. All patients had neurophysiologic monitoring [somatosensory-evoked potentials (SSEP), spontaneous electromyogram (EMG), and/or motor-evoked potential (MEP)].
  
  
  RESULTS
  Postoperative C5 root palsy occurred in 5 (2 with ACCF and 3 with PLF) cases (1.4%). In all cases, there were no changes in intraoperative neurophysiologic monitoring. C5 palsy did not occur before postoperative day 2.
  
  
  CONCLUSIONS
  Patients undergoing cervical decompression remain at risk for C5 root palsy despite use of monitoring. Given that all patients experienced delayed onset of C5 palsy, MEP, SSEP, and EMG may not be sensitive enough to assess the risk of developing C5 palsy.
authors.affiliation: Department of Neurosurgery, Medstar Georgetown University Hospital, 3700 Reservoir Road NW, 7 PHC, Washington, DC, 20007, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Spitz
authors.affiliation: Department of Neurosurgery, Medstar Georgetown University Hospital, 3700 Reservoir Road NW, 7 PHC, Washington, DC, 20007, USA. rocky.felbaum@gmail.com.
authors.forename: Daniel
authors.initials: D
authors.lastname: Felbaum
authors.affiliation: Department of Neurosurgery, Medstar Georgetown University Hospital, 3700 Reservoir Road NW, 7 PHC, Washington, DC, 20007, USA.
authors.forename: Nima
authors.initials: N
authors.lastname: Aghdam
authors.affiliation: Department of Neurosurgery, Medstar Georgetown University Hospital, 3700 Reservoir Road NW, 7 PHC, Washington, DC, 20007, USA. fasandhu@aol.com.
authors.forename: Faheem
authors.initials: F
authors.lastname: Sandhu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000601:surgery*; D004576:Electromyography; D019054:Evoked Potentials, Motor / Q000502:physiology; D005073:Evoked Potentials, Somatosensory / Q000502:physiology; D005260:Female; D006801:Humans; D064795:Intraoperative Neurophysiological Monitoring; D008297:Male; D008875:Middle Aged; D010243:Paralysis / Q000209:etiology*; D011183:Postoperative Complications; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
keywords: C5 palsy; Cervical spine surgery; Complications; IONM