Laminectomy Width and Postoperative C5 Palsy After Posterior Cervical Decompression Fusion for Cervical Spondylosis: A Comparative Cohort Study

BACKGROUND: Predicting which patients undergoing posterior cervical decompression and fusion (PCDF) will develop C5 palsy remains a significant challenge. We sought to determine whether a specific cervical laminectomy width in PCDF is associated with a reduced risk of postoperative C5 palsy. METHODS: We reviewed the medical records of patients who underwent PCDF from 2016 to 2021. Our primary outcome was the presence of C5 palsy, defined as loss of at least 1 manual muscle test grade of the deltoid and/or biceps on hospital discharge from baseline. Laminectomy width was measured on postoperative cervical computed tomography images, and groups were stratified based on decompressions <18 mm, 18 to 22 mm, and >22 mm. Preoperative C3 to C5 cord signal change, ossification of the posterior longitudinal ligament, C4 to C5 neuroforaminal stenosis, and the C2 to C7 Cobb angles were also assessed. RESULTS: = 0.003). Subgroup analysis of individual risk factors further identified a significantly higher risk of C5 palsy in patients with C3 to C5 cord signal change, greater C2 to C7 Cobb angles, and existing C4 to C5 neuroforaminal stenosis. CONCLUSIONS: Narrow laminectomy (<22 mm) was associated with a significantly lower incidence of C5 palsy compared with wider laminectomy (>22 mm). Preoperative C3 to C5 cord signal change, C4 to C5 foraminal stenosis, and greater C2 to C7 Cobb angles were also independently linked to significantly increased odds of developing postoperative C5 palsy. CLINICAL RELEVANCE: Developing C5 palsy is a significant cause of morbidity in patients undergoing PCDF. Performing a narrow laminectomy may help mitigate this risk and reduce patient morbidity.