C5 palsy (C5P) is a well-known, although rare complication of cervical spine decompression
surgery. In severe forms, C5P causes debilitating upper extremity weakness involving the
deltoids and/or biceps brachii muscles, ultimately diminishing these patients' quality of
life. Furthermore, about half of patients with C5P present with sensory deficits and/or
intractable pain in addition to the muscle weakness.
Prophylactic bilateral foraminotomy at the C5 level during cervical decompression surgery has
been studied recently with the hope that it will minimize the risk of developing a C5 nerve
root palsy postoperatively. Although the current literature provides some support for this
claim, there are insufficient data establishing this technique as a proven measure to reduce
the incidence of C5P. In the present study, we seek to evaluate the effect of bilateral
foraminotomy on postoperative C5P incidence rates.
Bilateral foraminotomy has been correlated with a reduced risk of developing C5P following
cervical decompression surgery, but an identical foraminotomy procedure has never been
applied in a randomized manner to all qualifying patients in a study. Additionally,
prophylactic foraminotomy has only been prospectively studied during laminoplasty. In the
proposed study, bilateral foraminotomy will be randomized to patients receiving cervical
decompression surgery (laminoplasty, laminectomy, fusion). This is a multicenter randomized
trial, including the following sites: Cleveland Clinic, Columbia University Medical Center,
and University of Southern California Spine Center. Patients undergoing cervical
decompression surgery will be consented and enrolled if they meet the inclusion and exclusion
criteria. Subsequently, incidence of C5P will be monitored to determine efficacy of
prophylactic C5 bilateral foraminotomy during cervical decompression.