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Year : 2017  |  Volume : 1  |  Issue : 1  |  Page : 22-24

Successful conservative treatment of a bilateral C5 palsy following posterior cervical decompression and fusion surgery for ossification of posterior longitudinal ligament

1 Department of Neurosurgery, Justus-Liebig-University, Giessen, Germany
2 Diagnostic Centre for Radiology and Neurology, Giessen, Germany

Correspondence Address:
Karsten Schöller
Department of Neurosurgery, Justus-Liebig-University, Klinikstrasse 33, 35392 Giessen
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/EJSS.EJSS_5_17

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We report a case of a progressive bilateral C5 palsy (C5P) following multilevel posterior cervical decompression and fusion surgery that was successfully treated with conservative management. A 58-year-old female patient with ossification of the posterior longitudinal ligament and resulting spinal canal stenosis underwent surgery in August 2015. Weakness in her both deltoid and biceps muscles was immediately detected after surgery and gradually deteriorated to severe paresis in the following 2 days. Postoperative magnetic resonance imaging showed sufficient decompression of the spinal cord with posterior shifting. However, residual neuroforaminal bilateral stenosis at levels C4/5 and C5/6 was found on postoperative computed tomography. After discussion of the therapeutic options, we decided to start conservative management including physical therapy and to follow the patient closely including clinical and neurophysiological examinations for the next 12 months. After 3 months, improvement of bilateral paresis was already evident. Muscle strength in the right biceps and the right deltoid muscles recovered completely within a year, but Grade 4 muscle weakness remained in the left deltoid and biceps muscles. Repetitive electromyography also showed continuous improvement of the interference patterns of the deltoid and biceps muscles. Although a standard management protocol for the treatment of postoperative C5P has not yet been established, a conservative therapy may be warranted even for severe and bilateral C5P.

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