Disclosures: Jason Lew, DO: No financial relationships or conflicts of interest

Case Diagnosis: A 59-year-old male who underwent elective C3-C7 posterior decompression and C3-T2 posterior cervical fusion with C5 palsy and post-operative seroma.

Case Description or Program Description: Post-operatively, he had immediate left arm and leg weakness followed by right arm weakness. He was diagnosed with suspected C5 nerve palsy and discharged to home. Patient returned two days later with worsening symptoms to his left arm and was re-admitted. Repeat MRI was negative for acute changes and he was discharged to acute inpatient rehabilitation. He had altered light touch and pinprick on his left arm diffusely and bilateral arm weakness with less than anti-gravity strength proximally and intact distal function. Patient had positive Hoffman’s and Babinski’s sign on the left, but absent reflexes bilaterally in biceps and brachioradialis.

Setting: Acute Inpatient Rehabilitation

Assessment/Results: EMG showed 2+ fibrillations to bilateral C5-C6 myotomes. MRI of brachial plexus was limited by hardware artifact, but showed increased T2 signal to R supraspinatus and R infraspinatus. A repeat MRI one month later showed post-op seroma at C6-T4 and signal abnormality of the spinal cord at C4-C5.

Discussion (relevance): C5 palsy is a complication of unclear etiology from cervical surgery resulting in motor deficits with variable sensory deficits. It has a higher incidence with posterior approaches. The deltoid is the most affected muscle, however it is common to have other muscle groups such as the biceps affected, as seen in this patient. C5 palsy generally has a favorable prognosis, if mild, with conservative treatment. Recovery usually occurs within 3-12 months. However, it can result in significant debilitation and poor recovery, particularly in severe cases with less than anti-gravity strength.

Conclusions: Diagnosis in this case was complicated by post-operative seroma and C5 palsy causing upper and lower motor signs, respectively. MRI findings were not seen in earlier studies and only present 1 month after initial injury which further delayed clinical diagnosis.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/c5-palsy-and-post-operative-seroma-after-cervical-fusion-with-upper-and-lower-motor-neuron-signs/