Bilateral C5 Palsy Following a Circumferential Surgery for Cervical Spondylotic Myelopathy: Case Report and Review (In press)

Background and Importance: The development of C5 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 it might occur as a bilateral anomaly. The value of intraoperative neurophysiologic monitoring in detection of iatrogenic acute versus delayed onset C5 palsy, the rarity of bilateral C5 palsy and its optimal management requires further discussion Case Description: A 49-year-old woman with quadriparesis due to cervical spondylotic myelopathy is presented. She underwent circumferential 360’ degree cervical spine surgery. This operation was subsequently complicated by a delayed bilateral C5 palsy, despite normal transcranial motor evoked potentials (MEPs). With the utilization of conservative treatment options, the complete resolution of this complication took roughly eight months. Conclusion: Bilateral C5 palsy is an extremely rare consequence of a multilevel cervical spine surgeries. Although, intraoperative monitoring of transcranial electrical stimulation–induced motor evoked potentials (MEPs) have high sensitivity and specificity in foreseeing acute onset C5 palsy, it cannot predict delayed onset palsy. With consideration of the current case, only 7 previously reported cases within all of medical literature. Further, conservative management in adherence to rigorous physical therapy may be an acceptable treatment