C5 Nerve Root Palsy: An Uncommon Postoperative Complication and Its Management

Case Reports

. 2022 Sep 9;14(9):e28988.


doi: 10.7759/cureus.28988.


eCollection 2022 Sep.

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Case Reports

Nikita H Seth et al.


Cureus.


.

Abstract

The standard treatment for multiple levels of cervical prolapsed intervertebral disk (PIVD) is anterior cervical decompression and fusion. Although it is associated with positive outcomes, it is also fraught with complications. In this report, we present an unusual postoperative case of a 58-year-old male who underwent anterior decompression and cervical fusion at two levels – C4-C5 and C5-C6 – for traumatic PIVD and developed a postoperative complication of unilateral C5 motor palsy, making it difficult for the patient to elevate the shoulder. This postoperative complication had no known cause, but it could be iatrogenic or due to structural variation. There is sparse research on possible ways to avoid this complication. Physiotherapy management is critical in improving the patient’s functional recovery. The neck and upper extremity functional measure scale and Neurogenic Claudication Outcome Score (NCOS) scale were used for measuring outcomes. The patient also had a two-year history of tingling and numbness in both lower extremities, which was treated conservatively. The difficulties that physiotherapists encounter in managing this uncommon postoperative complication in addition to the lumbar PIVD make it unique. The key to a better prognosis is early detection and management.


Keywords:

anterior decompression; c5 nerve root palsy; case report; cervical fusion; claudication; rehabilitation.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures


Figure 1



Figure 1. MRI of the cervical spine

(A) The blue arrow indicates multiple levels (C3-C6) where diffuse disc bulge indenting over the thecal sac is seen. (B) MRI of the full length of the spine. The upper blue arrow shows a disc bulge at the cervical spine and the lower blue arrow is indicative of a disc bulge between the fifth lumbar and first sacral vertebrae MRI: magnetic resonance imaging


Figure 2



Figure 2. Postoperative X-ray of the cervical spine

(A) Lateral view of X-ray where arrows indicate the placement of Jayon spacer between C4-C5 and C5-C6 level. (B) Anteroposterior view of the X-ray; red arrows indicate the spacer at multiple levels


Figure 3



Figure 3. Intraoperative image

The white arrow shows a 2-mm Jayon spacer


Figure 4



Figure 4. Rehabilitation exercises for the upper limb

(A) Shoulder abduction and (B) elbow flexion with minimal guidance by the therapist’s hand in the desired direction of motion


Figure 5



Figure 5. Graphical representation of outcome measures

Graph 1: presents the comparison of the neck and upper extremity functional scale on preoperative day zero and postoperative days 3, 15, and 30. Graph 2: represents a comparison of the Neurogenic Claudication Outcome Score taken prior to the administration of the physical therapy treatment and values that were taken in the second and fourth weeks post-initiation of treatment. Graph 3: shows the initial decline and the gradual rise in the strength of the biceps and deltoid muscles post-rehabilitation taken at various intervals by manual muscle testing

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