Incidence and prognostic factors of postoperative C5 palsy after cervical OPLL surgery: a nationwide prospective multicenter study
This prospective multicenter study examined the incidence, risk factors, and recovery course of C5 palsy after surgery for cervical ossification of the posterior longitudinal ligament in 482 patients treated at 28 institutions between 2015 and 2017. C5 palsy was defined as a postoperative decline of at least one grade in deltoid MMT strength. Overall, 6.0% of patients developed C5 palsy, with notable variation by surgical procedure: 4.0% after anterior decompression and fusion, 4.6% after laminoplasty, and 11.8% after posterior decompression and fusion. Nearly half of the affected patients developed symptoms on the day of surgery, and deltoid strength dropped from a mean of 4.7 preoperatively to 2.3 at onset. Over the following two years, 81% of patients regained their preoperative motor function. Better outcomes were observed in younger individuals and in those without concurrent biceps brachii weakness, whereas older patients and those with multimuscle involvement showed less favorable recovery. These findings clarify the expected clinical course of C5 palsy after OPLL surgery and highlight patient factors that may help guide prognosis and perioperative counseling.
Authors
- Yu Matsukura
- Kazuma Murata (ORCID: https://orcid.org/0000-0002-9285-6142)
- Shunsuke Fujibayashi (ORCID: https://orcid.org/0000-0003-0662-4298)
- Yukitaka Nagamoto (ORCID: https://orcid.org/0000-0002-7993-3959)
- Haruo Kanno (ORCID: https://orcid.org/0000-0003-1985-2257)
- Katsushi Takeshita (ORCID: https://orcid.org/0000-0001-8470-4555)
- Keiichi Katsumi (ORCID: https://orcid.org/0000-0002-3997-3593)
- Tomohiro Banno (ORCID: https://orcid.org/0000-0002-6938-7501)
- Masahiko Takahata (ORCID: https://orcid.org/0000-0002-2436-2175)
- Hiroaki Onuma (ORCID: https://orcid.org/0000-0001-6683-9691)
- K. Yamada
- Norihiro Nishida (ORCID: https://orcid.org/0000-0001-7754-6579)
- Satoru Egawa (ORCID: https://orcid.org/0000-0001-9367-3906)
- Kazuo Kusano
- Kenichiro Sakai
- Atsushi Kimura
- Takeo Furuya
- Kanji Mori
- Takashi Kaito
- Takashi Hirai
- Shunji Tsutsui
- Toshitaka Yoshii
- Hideaki Nakajima
- Tetsuro Ohba
- Yoshiharu Kawaguchi
- Masao Koda
- Hiroyuki Katoh
- Kei Ando
- Tsutomu Endo
- Narihito Nagoshi
- Hiroaki Nakashima
- Shiro Imagama
- Kanichiro Wada
- Satoshi Kato
- Hiroshi Moridaira
- Morio Matsumoto
- Satoshi Maki
- Masashi Yamazaki
- Hiroshi Taneichi
- Masayuki Miyagi
- Yasushi Oshima
Institutions
- Kanazawa University (JP)
- Kurume University (JP)
- University of Fukui (JP)
- Tokai University (JP)
- University of Tsukuba (JP)
- Jichi Medical University (JP)
- Hirosaki University (JP)
- Tokyo Medical University (JP)
- Chiba University (JP)
- Shiga University of Medical Science (JP)
- Yamaguchi University (JP)
- Wakayama Medical University (JP)
- Hokkaido University (JP)
- Kyoto University (JP)
- Hamamatsu University School of Medicine (JP)
- Keio University Hospital (JP)
- Kudanzaka Hospital (JP)
- University of Yamanashi Hospital (JP)
- Osaka Rosai Hospital (JP)
- Niigata University Medical and Dental Hospital (JP)
- Tohoku Medical and Pharmaceutical University Hospital (JP)
- Noguchi Hospital (JP)
- Research Organization of Information and Systems (JP)
- University of Toyama (JP)
- Nagoya University (JP)
- Kitasato University (JP)
- The University of Tokyo (JP)
- Dokkyo Medical University (JP)
- The University of Osaka (JP)
Publication Details
- Journal
- Scientific Reports
- Published
- 2026-03-31
- DOI
- https://doi.org/10.1038/s41598-026-45807-4
- Primary Topic
- Cervical and Thoracic Myelopathy
- Type
- article
- Field-Weighted Citation Impact
- 0.00
Funders
- Japan Agency for Medical Research and Development