C5 palsy after C5/6/7 posterior foraminal decompression

Medicine, 2020 · DOI: http://dx.doi.org/10.1097/MD.0000000000018817 · Published: January 1, 2020

Surgery Orthopedics Research Methodology & Design

Simple Explanation

This case report describes a patient who developed C5 palsy, a weakness in the shoulder muscles, after undergoing surgery to relieve pressure on nerves in the neck. The surgery, called microendoscopic foraminotomy, was performed at the C5/6 and C6/7 levels of the spine to address nerve compression, but surprisingly led to C5 palsy despite not directly involving the C5 nerve root. The authors suggest that the palsy may have been caused by heat generated from the surgical drill during the procedure, or due to variations in the formation of the brachial plexus, the network of nerves that controls movement and sensation in the arm.

Study Duration

3 months

Participants

A 43-year-old man

Evidence Level

Level 4, Case Report

Key Findings

1
A patient developed C5 palsy after undergoing microendoscopic foraminotomy at C5/6/7 levels, despite the procedure being intended to prevent nerve compression.
2
The patient's C5 palsy could not be explained by traditional theories of nerve root impingement or disruption of blood circulation to the spinal cord.
3
The authors hypothesize that the C5 palsy may be related to drill heat-induced radiculopathy or variations in the formation of the brachial plexus.

Research Summary

This case report describes a patient who experienced C5 palsy following microendoscopic foraminotomy at the C5/6/7 levels for radiculopathy, despite the procedure not directly decompressing the C5 nerve root. The authors discuss potential mechanisms for the C5 palsy, including drill heat-induced nerve damage and variations in the formation of the brachial plexus, as traditional explanations related to nerve root impingement or spinal cord blood flow disruption were not applicable in this case. The authors emphasize the importance of careful consideration when performing prophylactic foraminotomy for cervical posterior surgery, as the procedure itself can potentially cause C5 palsy, even without direct C4/5 level decompression.

Practical Implications

Surgical Technique Considerations

Surgeons should be aware of the potential for drill heat-induced nerve damage during foraminotomy procedures and take precautions to minimize heat generation.

Brachial Plexus Variability

Awareness of potential variations in brachial plexus anatomy is crucial for surgeons performing cervical spine procedures.

Prophylactic Foraminotomy Reassessment

The routine use of prophylactic foraminotomy to prevent C5 palsy should be carefully considered, weighing the potential benefits against the risk of causing C5 palsy.

Study Limitations

1
The local temperature while using the drill was not measured, so the cause of C5 palsy in this case is only predictable, not certain.
2
The diagnosis of drill heat-induced C5 palsy is the result of ruling out the generally reported cause of C5 palsy.
3
This is a single case report, limiting the generalizability of the findings.

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