Neurospine.  2019 Sep;16(3):558-562. 10.14245/ns.1938142.071.

Epidemiology of C5 Palsy after Cervical Spine Surgery: a 21-Center Study

  • 1Department of Neurosurgery, Hallym University Sacred Heart Hospital, Anyang, Korea.
  • 2Department of Neurosurgery, St. Vincent’s Hospital, The Catholic University of Korea, Suwon, Korea.
  • 3Department of Neurosurgery, Gyeongsang National University School of Medicine, Jinju, Korea.
  • 4Department of Neurosurgery, Yeungnam University Medical Center, Daegu, Korea.
  • 5Department of Neurosurgery, Chosun University Hospital, Gwangju, Korea.
  • 6Department of Neurosurgery, Dankook University Hospital, Cheonan, Korea.
  • 7Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
  • 8Department of Neurosurgery, Inje University Sanggye Paik Hospital, Seoul, Korea.
  • 9Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
  • 10Department of Neurosurgery, Chonnam University Hospital, Chonnam University College of Medicine, Gwangju, Korea.
  • 11Department of Neurosurgery, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Korea.
  • 12Department of Neurosurgery, Inje University Ilsan Paik Hospital, Goyang, Korea.
  • 13Department of Neurosurgery, Incheon St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea.
  • 14Department of Neurosurgery, Hanyang University Seoul Hospital, Seoul, Korea.
  • 15Department of Neurosurgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea.
  • 16Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
  • 17Department of Neurosurgery, Inje University Seoul Paik Hospital, Seoul, Korea.
  • 18Department of Neurosurgery, The Leon Wiltse Memorial Hospital, Anyang, Korea.
  • 19Department of Neurosurgery, Pusan National University Hospital, Busan, Korea.
  • 20Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
  • 21Department of Neurosurgery, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea.


C5 palsy is a severe complication after cervical spine surgery, the pathophysiology of which remains unclear. This multicenter study investigated the incidence of C5 palsy following cervical spine surgery in Korea.
We conducted a retrospective multicenter study involving 21 centers from the Korean Cervical Spine Study Group. The inclusion criteria were cervical spine surgery patients between 2012 and 2016, excluding cases of neck surgery. In patients with C5 palsy, the operative methods, disease category, onset time of C5 palsy, recovery time, C5 manual muscle testing (MMT) grade, and post-C5 palsy management were analyzed.
We collected 15,097 cervical spine surgery cases from 21 centers. C5 palsy occurred in 88 cases (0.58%). C5 palsy was more common in male patients (p=0.019) and after posterior approach procedures (p<0.001). C5 palsy usually occurred within 3 days after surgery (77 of 88, 87.5%) and most C5 palsy patients recovered within 6 months (51 of 88, 57.95%). Thirty C5 palsy patients (34.09%) had motor weakness, with an MMT grade≤2. Only four C5 palsy patients (4.5%) did not recover during follow-up. Posterior cervical foraminotomy was performed in 7 cases (7.95%), and steroids were used in 56 cases (63.63%). Twenty-six cases (29.55%) underwent close observation only.
The overall incidence of C5 palsy was relatively low (0.58%). C5 palsy was more common after posterior cervical surgery and in male patients. C5 palsy usually developed within 3 days after surgery, and more than half of patients with C5 palsy recovered within 6 months.


C5 palsy; Cervical spine surgery; Epidemiology

MeSH Terms

Follow-Up Studies
Retrospective Studies
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