Sidney Tucker, MD
Resident physician
University of North Carolina
Chapel Hill, North Carolina, United States
Taylor Baker, DO
Resident physician
University of North Carolina
Durham, North Carolina, United States
Christine A. Cleveland, MD
Associate Professor
UNC Healthcare
Chapel Hill, North Carolina, United States
67-year-old male presented with neck pain, weakness and paresthesias in bilateral upper extremities following C2-C7 PCDF found to have postoperative bilateral C5 palsy.
Case Description:
The patient presented with neck pain radiating down bilateral upper extremities with associated weakness and paresthesias. Physical exam showed diminished sensation in bilateral C5-T1 distribution, decreased strength of proximal muscles and bilateral hand intrinsics, hyperreflexia, and positive Hoffman’s sign bilaterally. MRI cervical spine showed bilateral neuroforaminal stenosis and severe spinal canal stenosis at C3-C5 with associated cord compression and edema. Neurosurgery performed C3-C5 laminectomies and extension of posterior fusion to C2-C7. Four days following surgery he had worsening neck pain and proximal arm weakness. Exam showed worsening proximal BUE weakness. Repeat MRI spine without evidence of stenosis due to recent decompression but persistent cord signal change at C3-C5. Patient’s presentation most consistent with bilateral C5 palsy. The patient was treated with corticosteroids and received inpatient rehab. The palsy completely resolved 6 months following surgery.
Discussions:
C5 palsy is a known complication following cervical spine surgery. Common presentation includes pain, decreased strength of the deltoid and/or biceps brachii, and sensory deficits. Symptoms typically occur immediately after surgery to 2 months post-op. Although affected patients typically have unilateral palsy, this unique case demonstrates the possibility of bilateral palsy. Most patients recover gradually and return to baseline. C5 palsy is thought to be due to either nerve root injury from mechanical damage during surgery or due to segmental spinal cord impairment caused by operative ischemia or postoperative reperfusion. Treatment is usually with therapies, range of motion exercises, and corticosteroids.
Conclusions:
C5 nerve palsy should be considered with recurrence of proximal upper extremity motor and sensory deficits following cervical spine surgery. C5 palsy can occur unilaterally or bilaterally and is treated conservatively with the majority of patients experiencing full neurologic recovery.
