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C5 Root Palsy Following Cervical Spinal Surgery

Intraoperative Neuromonitoring is invaluable in surgical procedures that place neural structures at risk. The main goal of any surgical intervention has been and continues to be the protection of the patient and prevention of iatrogenic complications. The implementation of Intraoperative electromyography (EMG) allows real time feedback to the surgeon during procedures regarding tolerance of individual nerve roots.

Cervical spinal surgery is commonly performed without Intraoperative Neuromonitoring because it carries a low risk of spinal cord injury. However, it is common that patients undergoing cervical spinal surgery suffer post-operative C5 root palsy. The C5 root is at higher risk because it is short in length. Because of resultant severe deltoid and bicep muscle weakness, this injury is debilitating to the patient. Often the patient cannot return to work for many months following rehabilitative therapy. Cervical root traction may contribute to post-operative C5 palsy and significant shoulder distraction (during patient positioning) may contribute to C5 palsy secondary to brachial plexus injury.

Each patient tolerates root traction or distraction differently. Cervical EMG monitoring is an important adjunct to cervical spinal surgery to alert the surgeon to activity seen in free-running EMG recordings.

EMG monitoring is a useful real time Intraoperative diagnostic tool during these procedures because it allows the surgeon to make appropriate alterations in
patient positioning and/or surgical activities when firing is noted.

Reference:

“Palsies of the fifth cervical nerve root after cervical decompression: prevention
using continuous Intraoperative electromyography monitoring.”

Juan C. Jimenez, M.D. Sepehr Sani, M.D. Berton Braverman, PhD. Harel Deutsch,
M.D, and John Ratliff, M.D.

Departments of Neurological Surgery and Anesthesiology, Rush University
Medical Center, Chicago and Chicago Institute of neurosurgery and
Neuroresearch Medical Group, Chicago, Illinois.

Michelle Nagel R.EEG/EPT, CNIM
Synapse Neuromonitoring, Inc.
Mnagel@synapseneuro.com

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