520 Nerve Transfers for Post-Operative C5 Palsy: A Case Series

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INTRODUCTION: C5 palsy is a known complication of cervical spine surgery, occurring in up to 10% of cases. It typically presents with weakness in the Deltoid and Biceps brachii muscles. While approximately 85% of patients recover functional strength with conservative management, up to 15% may experience persistent deficits. As the volume of cervical spine procedures increases, there is a critical need to find optimal management strategies for C5 palsy. METHODS: This retrospective, single-center case series included patients who developed C5 palsy following cervical spine surgery and subsequently underwent nerve transfers between 2018 and 2024. Patients of any age were included. All patients underwent single or multiple nerve transfers targeting one or both upper limbs. The assessed outcome was motor recovery, per the Medical Research Council (MRC) grading of motor strength. RESULTS: Four patients were included in this series. Cervical spine procedures performed included C2–T2 posterior cervical fusion, C3–C7 posterior cervical fusion, and C4–C7 anterior cervical discectomy and fusion. All patients developed C5 palsy within the first postoperative week; one patient developed a bilateral C5 palsy. Time to referral for peripheral nerve evaluation was 4, 5, 6, and 20 months postoperatively for the four patients. Diagnostic workup included MRI, electromyography (EMG), and nerve conduction studies (NCS) prior to nerve transfers. CONCLUSIONS: Nerve transfers represent a viable option for patients with persistent motor deficits following C5 palsy, particularly when performed within a critical window. Timely EMG and NCS evaluations – in our experience at 5 months postoperatively can save the valuable time and appropriately identify candidates for nerve transfers to regain motor function.

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