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Neurospine > Volume 16(3); 2019 > Article
DOI:    Published online September 30, 2019.
Epidemiology of C5 Palsy after Cervical Spine Surgery: A 21-Center Study
Jae Keun Oh1, Jae Taek Hong2, Dong Ho Kang3, Sang-Woo Kim4, Seok Won Kim5, Young Jin Kim6, Chun Kee Chung7, Jun Jae Shin8, Seong Yi9, Jung Kil Lee10, Jun Ho Lee11, Chang-Hyun Lee12, Ho Jin Lee13, Hyoung-Joon Chun14, Dae-Chul Cho15, Yong Eun Cho16, Yong Jun Jin17, Kyung-Chul Choi18, In Ho Han19, Seung-Jae Hyun20, Jung-Woo Hur21, Ki-Jeong Kim20 
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
Corresponding Author:  Ki-Jeong Kim
Tel: +82-31-787-7169   Email:
Received: May 1, 2019   Revised: July 16, 2019   Accepted: July 19, 2019
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.
Keywords: C5 palsy, Cervical spine surgery, Epidemiology

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