Bilateral C۵ Palsy Following A Circumferential Surgery for Cervical Spondylotic Myelopathy: A Case Report and Review

Background and Importance: The development of C۵ root palsy is a well-known potential complication of cervical spine surgeries for the correction of cervical spondylotic myelopathy. It typically occurs unilaterally, but on extremely rare occasions, bilaterally. The value of intraoperative neurophysiologic monitoring in detecting iatrogenic acute versus delayed onset C۵ palsy, the rarity of bilateral C۵ palsy, and its optimal management require further discussion. Case Presentation: A ۴۹-year-old woman with quadriparesis due to cervical spondylotic myelopathy is presented. She underwent circumferential ۳۶۰° cervical spine surgery. This operation was subsequently complicated by a delayed bilateral C۵ palsy, despite normal transcranial motor evoked potentials (MEPs). With the utilization of conservative treatment, the complete resolution of this complication took roughly eight months. Conclusion: Bilateral C۵ palsy is an infrequent consequence of multilevel cervical spine surgeries. Although intraoperative monitoring of transcranial electrical stimulation-induced MEPs has high sensitivity and specificity in foreseeing the acute-onset C۵ palsy, it cannot predict delayed-onset palsy. Including the current case, only seven cases have been reported in the medical literature. Overall, conservative management in adherence to rigorous physical therapy may be an acceptable treatment.

Keywords:

Bilateral C۵ Palsy , Surgery , Cervical , Spondylotic myelopathy , Instrumentation , Laminectomy , Physiotherapy