Preoperative Clinical and Radiographic Variables Predict Postoperative C5 Palsy

Zach Pennington, Daniel Lubelski, Adam D'Sa, Erick Westbroek, A. Karim Ahmed, Matthew Goodwin, Timothy F Witham, Ali Bydon, Nicholas Theodore, Daniel Sciubba

Research output: Contribution to journalArticle

Abstract

Background: Postoperative C5 palsy affects 8% of patients undergoing posterior cervical decompression. It is associated with a period functional disability that may exceed 12 months and increase direct care costs > $2000. Methods: All patients undergoing posterior cervical decompression at a single tertiary-care facility for degenerative conditions were evaluated for preoperative imaging, clinical presentation, surgical operation, and postoperative course. We sought to identify those variables predictive of postoperative C5 palsy. Results: Of 221 included patients (mean age, 63 years; 54% male), 12.2% experienced C5 palsy. On univariate analysis, C5 palsy was associated with foraminal diameter (P = 0.0005), spinal cord cross-sectional area (P = 0.11), number of levels undergoing laminectomy (P = 0.14), and clinical presentation of dropping objects (P = 0.07), hand clumsiness (P = 0.13), or paresthesias in the upper extremities (P = 0.08). Foraminal diameter (odds ratio, 0.31 per mm increase; 95% confidence interval, 0.16–0.60; P < 0.001) and patient report of gait disturbance (odds ratio, 0.53; 95% confidence interval, 0.33–0.85; P = 0.008) were the only significant predictors on multivariate analysis. A foraminal diameter <2 mm had 2-fold greater odds of postoperative C5 palsy. A receiver operating curve for the multivariate logistic model had an associated C-statistic of 0.7818. The absolute error of this model was 9.3% on internal validation. Conclusions: Foraminal stenosis most strongly predicted postoperative C5 palsy. A proof-of-concept model incorporating foramen size, as well as clinical complaints of paresthesias, hand clumsiness, and gait abnormality, successfully predicts the occurrence of postoperative palsy with an overall accuracy of 78%.

Original languageEnglish (US)
JournalWorld neurosurgery
DOIs
StatePublished - Jan 1 2019

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Paralysis
Paresthesia
Decompression
Gait
Hand
Odds Ratio
Confidence Intervals
Laminectomy
Tertiary Healthcare
Upper Extremity
Spinal Cord
Pathologic Constriction
Multivariate Analysis
Logistic Models
Costs and Cost Analysis

Keywords

  • C5 palsy
  • Cervical spine
  • Degenerative spine disease
  • Posterior cervical decompression

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Preoperative Clinical and Radiographic Variables Predict Postoperative C5 Palsy. / Pennington, Zach; Lubelski, Daniel; D'Sa, Adam; Westbroek, Erick; Ahmed, A. Karim; Goodwin, Matthew; Witham, Timothy F; Bydon, Ali; Theodore, Nicholas; Sciubba, Daniel.

In: World neurosurgery, 01.01.2019.

Research output: Contribution to journalArticle

Pennington, Zach ; Lubelski, Daniel ; D'Sa, Adam ; Westbroek, Erick ; Ahmed, A. Karim ; Goodwin, Matthew ; Witham, Timothy F ; Bydon, Ali ; Theodore, Nicholas ; Sciubba, Daniel. / Preoperative Clinical and Radiographic Variables Predict Postoperative C5 Palsy. In: World neurosurgery. 2019.
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abstract = "Background: Postoperative C5 palsy affects 8{\%} of patients undergoing posterior cervical decompression. It is associated with a period functional disability that may exceed 12 months and increase direct care costs > $2000. Methods: All patients undergoing posterior cervical decompression at a single tertiary-care facility for degenerative conditions were evaluated for preoperative imaging, clinical presentation, surgical operation, and postoperative course. We sought to identify those variables predictive of postoperative C5 palsy. Results: Of 221 included patients (mean age, 63 years; 54{\%} male), 12.2{\%} experienced C5 palsy. On univariate analysis, C5 palsy was associated with foraminal diameter (P = 0.0005), spinal cord cross-sectional area (P = 0.11), number of levels undergoing laminectomy (P = 0.14), and clinical presentation of dropping objects (P = 0.07), hand clumsiness (P = 0.13), or paresthesias in the upper extremities (P = 0.08). Foraminal diameter (odds ratio, 0.31 per mm increase; 95{\%} confidence interval, 0.16–0.60; P < 0.001) and patient report of gait disturbance (odds ratio, 0.53; 95{\%} confidence interval, 0.33–0.85; P = 0.008) were the only significant predictors on multivariate analysis. A foraminal diameter <2 mm had 2-fold greater odds of postoperative C5 palsy. A receiver operating curve for the multivariate logistic model had an associated C-statistic of 0.7818. The absolute error of this model was 9.3{\%} on internal validation. Conclusions: Foraminal stenosis most strongly predicted postoperative C5 palsy. A proof-of-concept model incorporating foramen size, as well as clinical complaints of paresthesias, hand clumsiness, and gait abnormality, successfully predicts the occurrence of postoperative palsy with an overall accuracy of 78{\%}.",
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AU - Pennington, Zach

AU - Lubelski, Daniel

AU - D'Sa, Adam

AU - Westbroek, Erick

AU - Ahmed, A. Karim

AU - Goodwin, Matthew

AU - Witham, Timothy F

AU - Bydon, Ali

AU - Theodore, Nicholas

AU - Sciubba, Daniel

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N2 - Background: Postoperative C5 palsy affects 8% of patients undergoing posterior cervical decompression. It is associated with a period functional disability that may exceed 12 months and increase direct care costs > $2000. Methods: All patients undergoing posterior cervical decompression at a single tertiary-care facility for degenerative conditions were evaluated for preoperative imaging, clinical presentation, surgical operation, and postoperative course. We sought to identify those variables predictive of postoperative C5 palsy. Results: Of 221 included patients (mean age, 63 years; 54% male), 12.2% experienced C5 palsy. On univariate analysis, C5 palsy was associated with foraminal diameter (P = 0.0005), spinal cord cross-sectional area (P = 0.11), number of levels undergoing laminectomy (P = 0.14), and clinical presentation of dropping objects (P = 0.07), hand clumsiness (P = 0.13), or paresthesias in the upper extremities (P = 0.08). Foraminal diameter (odds ratio, 0.31 per mm increase; 95% confidence interval, 0.16–0.60; P < 0.001) and patient report of gait disturbance (odds ratio, 0.53; 95% confidence interval, 0.33–0.85; P = 0.008) were the only significant predictors on multivariate analysis. A foraminal diameter <2 mm had 2-fold greater odds of postoperative C5 palsy. A receiver operating curve for the multivariate logistic model had an associated C-statistic of 0.7818. The absolute error of this model was 9.3% on internal validation. Conclusions: Foraminal stenosis most strongly predicted postoperative C5 palsy. A proof-of-concept model incorporating foramen size, as well as clinical complaints of paresthesias, hand clumsiness, and gait abnormality, successfully predicts the occurrence of postoperative palsy with an overall accuracy of 78%.

AB - Background: Postoperative C5 palsy affects 8% of patients undergoing posterior cervical decompression. It is associated with a period functional disability that may exceed 12 months and increase direct care costs > $2000. Methods: All patients undergoing posterior cervical decompression at a single tertiary-care facility for degenerative conditions were evaluated for preoperative imaging, clinical presentation, surgical operation, and postoperative course. We sought to identify those variables predictive of postoperative C5 palsy. Results: Of 221 included patients (mean age, 63 years; 54% male), 12.2% experienced C5 palsy. On univariate analysis, C5 palsy was associated with foraminal diameter (P = 0.0005), spinal cord cross-sectional area (P = 0.11), number of levels undergoing laminectomy (P = 0.14), and clinical presentation of dropping objects (P = 0.07), hand clumsiness (P = 0.13), or paresthesias in the upper extremities (P = 0.08). Foraminal diameter (odds ratio, 0.31 per mm increase; 95% confidence interval, 0.16–0.60; P < 0.001) and patient report of gait disturbance (odds ratio, 0.53; 95% confidence interval, 0.33–0.85; P = 0.008) were the only significant predictors on multivariate analysis. A foraminal diameter <2 mm had 2-fold greater odds of postoperative C5 palsy. A receiver operating curve for the multivariate logistic model had an associated C-statistic of 0.7818. The absolute error of this model was 9.3% on internal validation. Conclusions: Foraminal stenosis most strongly predicted postoperative C5 palsy. A proof-of-concept model incorporating foramen size, as well as clinical complaints of paresthesias, hand clumsiness, and gait abnormality, successfully predicts the occurrence of postoperative palsy with an overall accuracy of 78%.

KW - C5 palsy

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KW - Degenerative spine disease

KW - Posterior cervical decompression

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