UMMS Affiliation

Department of Orthopedics and Physical Rehabilitation

Publication Date


Document Type



Adult; Aged; Brachial Plexus Neuropathies; Cervical Vertebrae; Cohort Studies; Decompression, Surgical; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Paralysis; Postoperative Complications; Predictive Value of Tests; Preoperative Care; Registries; Retrospective Studies; Risk Assessment; Rotation; Sensitivity and Specificity; Severity of Illness Index; Spinal Cord; Spinal Nerve Roots; Spinal Stenosis; Treatment Outcome; Young Adult


Orthopedics | Rehabilitation and Therapy | Surgery


BACKGROUND: C5 nerve palsy is a known complication of cervical spine surgery. The development and etiology of this complication are not completely understood. The purpose of the present study was to determine whether rotation of the cervical spinal cord predicts the development of a C5 palsy.

METHODS: We performed a retrospective review of prospectively collected spine registry data as well as magnetic resonance images. We reviewed the records for 176 patients with degenerative disorders of the cervical spine who underwent anterior cervical decompression or corpectomy within the C4 to C6 levels. Our measurements included area for the spinal cord, space available for the cord, and rotation of the cord with respect to the vertebral body.

RESULTS: There was a 6.8% prevalence of postoperative C5 nerve palsy as defined by deltoid motor strength of /= 11 degrees ) and palsy (point-biserial correlation = 0.94; p < 0.001). A diagnostic criterion of 6 degrees of rotation could identify patients who had a C5 palsy (sensitivity = 1.00 [95% confidence interval, 0.70 to 1.00], specificity = 0.97 [95% confidence interval, 0.93 to 0.99], positive predictive value = 0.71 [95% confidence interval, 0.44 to 0.89], negative predictive value = 1.00 [95% confidence interval, 0.97 to 1.00]).

CONCLUSIONS: Our evidence suggests that spinal cord rotation is a strong and significant predictor of C5 palsy postoperatively. Patients can be classified into three types, with Type 1 representing mild rotation (0 degrees to 5 degrees ), Type 2 representing moderate rotation (6 degrees to 10 degrees ), and Type 3 representing severe rotation (>/= 11 degrees ). The rate of C5 palsy was zero of 159 in the Type-1 group, eight of thirteen in the Type-2 group, and four of four in the Type-3 group. This information may be valuable for surgeons and patients considering anterior surgery in the C4 to C6 levels.

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Copyright © 2013. The Journal of Bone and Joint Surgery, Inc. Publisher PDF posted as allowed by the publisher's author rights policy at

DOI of Published Version



J Bone Joint Surg Am, 2012 Sep 05;94(17):1605-1609. doi: 10.2106/JBJS.K.00664. Link to article on publisher's site

Journal/Book/Conference Title

The Journal of bone and joint surgery. American volume

Related Resources

Link to Article in PubMed

PubMed ID




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