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<p>C5 nerve root palsy (C5P) is a significant complication that can adversely affect postoperative outcomes in patients undergoing surgery for cervical degenerative disease (CDD). However, its risk factors have not been systematically identified. This study aimed to systematically evaluate and identify the risk factors associated with postoperative C5P in patients with CDD.&#xa0;A comprehensive literature search was conducted in PubMed, Embase, and the Cochrane Library for studies published up to October 9, 2024. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using either fixed- or random-effects models, depending on the degree of heterogeneity. The quality of evidence for each risk factor was graded as high (Class I), moderate (Class II or III), or low (Class IV) based on sample size, Egger’s test p-values, and between-study heterogeneity. Sensitivity analyses (leave-one-out) and subgroup analyses based on incidence rates were performed to explore the sources of heterogeneity and assess the robustness of the results. Publication bias was evaluated using funnel plots, trim-and-fill analysis, and Egger’s regression test.&#xa0;A total of 25 cohort studies comprising 7,932 participants were included. High-quality (Class I) evidence indicated that ossification of the posterior longitudinal ligament (OPLL) (OR, 2.69; 95% CI, 2.04–3.56; I2 = 37.72; p &lt; 0.001) were significantly associated with an increased risk of postoperative C5P. Moderate-quality (Class II or III) evidence supported associations with male sex (OR, 1.61; 95% CI, 1.11–2.33; I2 = 12.81; p = 0.01), intervertebral foramen width &lt; 3 mm (OR, 7.50; 95% CI, 2.74–20.50; I2 = 49.95; p &lt; 0.001), cervical spondylotic myelopathy (CSM) (OR, 1.56; 95% CI, 1.07–2.26; I2 = 46.66; p = 0.02), age &gt; 60 years (OR, 1.05; 95% CI, 1.01–1.09; I2 = 58.00; p = 0.02), high signal intensity changes in the spinal cord on Magnetic resonance imaging (MRI) (OR, 1.83; 95% CI, 1.06–3.18; I2 = 65.66; p = 0.03), and posterior surgical approaches (OR, 2.21; 95% CI, 1.24–3.95; I2 = 80.77; p = 0.01). In contrast, neither high- nor moderate-quality evidence supported a significant association between C5P and diabetes mellitus (OR, 1.40; 95% CI, 0.90–2.18; I2 = 0.00; p = 0.13) or smoking (OR, 0.79; 95% CI, 0.47–1.31; I2 = 62.00; p = 0.36).&#xa0;This meta-analysis systematically identified factors associated with postoperative C5 palsy (C5P) in patients with cervical degenerative disease (CDD), including six patient-related factors (OPLL, male sex, narrow intervertebral foramen, advanced age, CSM and spinal cord signal changes on MRI) and one surgery-related factors (posterior surgical approach). However, as all included studies were retrospective and most associations showed only modest effect sizes, these results should be interpreted with caution and cannot infer causality. Nevertheless, they may aid in early risk stratification and preventive strategies in the surgical management of CDD.</p>

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Risk factors for C5 nerve root palsy following surgery for cervical degenerative disease : a systematic review and meta-analysis

  • 期刊论文

  • 发表日期：

    2026年1月10日

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  • Mingzhu Huang,
  • Kang Chen,
  • Yujin Zhang,
  • Lanxin Zhang,
  • Changyu Liu,
  • Xuan Liu,
  • Xiangzhuo Liu,
  • Ningyuan Li,
  • Ying Lu,
  • Mingjiang Luo,
  • Zhihong Xiao,
  • Liquan Li

摘要

C5 nerve root palsy (C5P) is a significant complication that can adversely affect postoperative outcomes in patients undergoing surgery for cervical degenerative disease (CDD). However, its risk factors have not been systematically identified. This study aimed to systematically evaluate and identify the risk factors associated with postoperative C5P in patients with CDD. A comprehensive literature search was conducted in PubMed, Embase, and the Cochrane Library for studies published up to October 9, 2024. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using either fixed- or random-effects models, depending on the degree of heterogeneity. The quality of evidence for each risk factor was graded as high (Class I), moderate (Class II or III), or low (Class IV) based on sample size, Egger’s test p-values, and between-study heterogeneity. Sensitivity analyses (leave-one-out) and subgroup analyses based on incidence rates were performed to explore the sources of heterogeneity and assess the robustness of the results. Publication bias was evaluated using funnel plots, trim-and-fill analysis, and Egger’s regression test. A total of 25 cohort studies comprising 7,932 participants were included. High-quality (Class I) evidence indicated that ossification of the posterior longitudinal ligament (OPLL) (OR, 2.69; 95% CI, 2.04–3.56; I2 = 37.72; p < 0.001) were significantly associated with an increased risk of postoperative C5P. Moderate-quality (Class II or III) evidence supported associations with male sex (OR, 1.61; 95% CI, 1.11–2.33; I2 = 12.81; p = 0.01), intervertebral foramen width < 3 mm (OR, 7.50; 95% CI, 2.74–20.50; I2 = 49.95; p < 0.001), cervical spondylotic myelopathy (CSM) (OR, 1.56; 95% CI, 1.07–2.26; I2 = 46.66; p = 0.02), age > 60 years (OR, 1.05; 95% CI, 1.01–1.09; I2 = 58.00; p = 0.02), high signal intensity changes in the spinal cord on Magnetic resonance imaging (MRI) (OR, 1.83; 95% CI, 1.06–3.18; I2 = 65.66; p = 0.03), and posterior surgical approaches (OR, 2.21; 95% CI, 1.24–3.95; I2 = 80.77; p = 0.01). In contrast, neither high- nor moderate-quality evidence supported a significant association between C5P and diabetes mellitus (OR, 1.40; 95% CI, 0.90–2.18; I2 = 0.00; p = 0.13) or smoking (OR, 0.79; 95% CI, 0.47–1.31; I2 = 62.00; p = 0.36). This meta-analysis systematically identified factors associated with postoperative C5 palsy (C5P) in patients with cervical degenerative disease (CDD), including six patient-related factors (OPLL, male sex, narrow intervertebral foramen, advanced age, CSM and spinal cord signal changes on MRI) and one surgery-related factors (posterior surgical approach). However, as all included studies were retrospective and most associations showed only modest effect sizes, these results should be interpreted with caution and cannot infer causality. Nevertheless, they may aid in early risk stratification and preventive strategies in the surgical management of CDD.