Fujikawa Yoshiki, Ikeda Naokado, Sakai Kosuke, Yagi Ryokichi, Hiramatsu Ryo, Kameda Masahiro, Nonoguchi Naosuke, Furuse Motomasa, Kawabata Shinji, Yokoyama Kunio, Kawanishi Masahiro, Fujishiro Takahiro, Park Yangtae, Tanabe Hideki, Takami Toshihiro, Wanibuchi Masahiko
Department of Neurosurgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan.
Department of Neurosurgery, Takeda General Hospital, 28-1 Ishidamoriminami-cho, Fushimi, Kyoto 601-1495, Japan.
J Clin Neurosci. 2025 Feb;132:111000. doi: 10.1016/j.jocn.2024.111000. Epub 2024 Dec 25.
C5 palsy is a frequent complication following cervical spine surgery, particularly after posterior approaches. Although several risk factors have been proposed, the incidence of C5 palsy after anterior cervical discectomy and fusion (ACDF) remains less well understood. This study aims to elucidate the risk factors and neurological recovery associated with C5 palsy following ACDF.
A total of 330 patients who underwent one or two-level ACDF between January 2018 and December 2022 across three institutions within the neurosurgical training program were retrospectively included and analyzed. Demographic, surgical, and radiological data were collected.
Sixteen (4.8 %) patients developed postoperative C5 palsy, with a significantly high incidence observed in patients exhibiting preoperative symptoms (radiculopathy or radiculomyelopathy) and undergoing two-level ACDF (p-values 0.008 and 0.018, respectively). No other demographic or radiological factors were associated with C5 palsy. Eleven of 16 (68.8 %) patients experienced C5 palsy within 1 day post-surgery (early-onset group), whereas the remaining five developed symptoms between 4 to 15 days post-surgery (late-onset group). At one year post-surgery, the late-onset group demonstrated superior recovery from C5 palsy compared to the recovery noted in the early-onset group (100 % vs 44.4 %).
Surgeons should be cognizant of the potential for C5 palsy following one- or two-level ACDF, despite generally favorable neurological outcomes. The timing of C5 palsy onset post-ACDF, potentially influenced by mechanisms such as direct injury and ischemia-reperfusion injury, could impact the recovery prognosis. Careful surgical procedure might be the key to success.
C5 麻痹是颈椎手术后常见的并发症，尤其是后路手术之后。尽管已经提出了多种风险因素，但颈椎前路椎间盘切除融合术（ACDF）后 C5 麻痹的发生率仍了解较少。本研究旨在阐明 ACDF 后与 C5 麻痹相关的风险因素及神经功能恢复情况。
回顾性纳入并分析了 2018 年 1 月至 2022 年 12 月期间在神经外科培训项目的三个机构接受单节段或双节段 ACDF 的 330 例患者。收集了人口统计学、手术和影像学数据。
16 例（4.8%）患者术后发生 C5 麻痹，术前有症状（神经根病或神经根脊髓病）且接受双节段 ACDF 的患者发生率显著较高（p 值分别为 0.008 和 0.018）。没有其他人口统计学或影像学因素与 C5 麻痹相关。16 例患者中有 11 例（68.8%）在术后 1 天内出现 C5 麻痹（早发组），其余 5 例在术后 4 至 15 天出现症状（晚发组）。术后 1 年，晚发组 C5 麻痹的恢复情况优于早发组（100% 对 44.4%）。
尽管通常神经功能预后良好，但外科医生应认识到单节段或双节段 ACDF 后发生 C5 麻痹的可能性。ACDF 后 C5 麻痹发生的时间可能受直接损伤和缺血再灌注损伤等机制影响，进而可能影响恢复预后。谨慎的手术操作可能是成功的关键。
