Incidence of C5 Palsy and Recovery Rate After Cervical Spine Surgery: A Systematic Review and Meta-Analysis

Neurosurgery 98:520–542, 2026

This systematic review and meta-analysis quantifies C5 nerve palsy incidence and recovery following various cervical spine surgeries, comparing anterior and posterior approaches across 155 studies. Pooled rates show higher C5 palsy after posterior procedures (laminectomy 8%, PCDF 7.03%, laminoplasty 5.11%) versus anterior ACDF (2.61%), with overall low permanence rates.

The paper details methods, study selection, heterogeneity, and limitations, and emphasizes the need for standardized diagnostic criteria, prospective cohorts, and treatment algorithms. Findings aim to inform surgical decision-making, patient counseling, and future research priorities to mitigate C5 palsy risk.

C5 palsy incidence: Highest after laminectomy (8%), followed by posterior cervical decompression and fusion (PCDF, 7.03%), laminoplasty (5.11%), corpectomy (4.16%), and lowest after anterior cervical diskectomy and fusion (ACDF, 2.61%).

Permanent C5 palsy rates: Low across all procedures—laminectomy (1.44%), PCDF (1.02%), laminoplasty (0.28%), ACDF (1.06%); no pooled data for corpectomy.

Posterior approaches risk: Posterior decompression procedures (laminectomy, PCDF, laminoplasty) carry a higher risk of C5 palsy than anterior approaches (ACDF, corpectomy).

Resolution and recovery: Most C5 palsy cases are transient and resolve within months; permanent deficits are uncommon with proper follow-up and care.

Surgical decision-making: Choice of approach should consider C5 palsy risk, especially in patients with anatomic risk factors (e.g., narrow foramina, preexisting kyphosis).

Economic impact: C5 palsy increases healthcare costs significantly, with up to $347,000 in the first year and ongoing annual costs of about $42,000 for permanent deficits.

Standardized protocols lacking: There is no consensus on optimal management; most strategies are institution-specific and anecdotal, highlighting the need for standardized treatment protocols.

Research gaps: High study heterogeneity, inconsistent reporting, and lack of long-term data—especially for corpectomy—limit understanding; further prospective studies on risk factors and outcomes are needed.