• Jacob A Miller, Daniel Lubelski, Matthew D Alvin, Edward C Benzel, and Thomas E Mroz.
• Cleveland Clinic Lerner College of Medicine, 9500 Euclid Ave., NA41, Cleveland, OH 44195, USA; Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave., S40, Cleveland, OH 44195, USA; Department of Neurological Surgery, Cleveland Clinic, 9500 Euclid Ave., S40, Cleveland, OH 44195, USA. Electronic address: millerj13@ccf.org.
• Spine J. 2014 Dec 1;14(12):2854-60.

Background ContextC5 palsy is a debilitating postoperative complication of cervical decompression surgery. Although the prognosis is typically good, patients may be unable to perform basic activities of daily living, resulting in a decreased quality of life. No studies have investigated the quality-of-life and financial implications.PurposeThe aim of the study was to determine the impact on quality-of-life and costs of C5 palsy after posterior cervical decompression and fusion (PCDF).Study Design/SettingA 2:1 matched retrospective cohort study was conducted at a single tertiary-care institution between 2007 and 2012.Patient SampleIndividuals who had undergone PCDF were included.Outcome MeasuresSelf-reported: Euroqol-5 Dimensions quality-of-life survey. Physiologic: postoperative change in deltoid and biceps strength via manual muscle testing. Functional: cost of interventions and missed workdays postoperatively.MethodsIndividuals with postoperative C5 palsy were matched to controls based on age, gender, body mass index, and diagnosis. Demographic, operative, postoperative, quality-of-life, and cost data were collected for both the C5 palsy and control groups, with 1-year follow-up.ResultsWe reviewed 245 patients who underwent PCDF and 17 were identified (6.9%) with C5 palsy and matched to 34 controls. No significant differences in demographic or operative characteristics were observed between groups. The C5 palsy group had a significantly reduced capacity for self-care in the immediate postoperative (2.0±0.71 vs. 1.2±0.4, p<.001) and long-term (1.6±0.6 vs. 1.2±0.4, p=.004) periods and a significantly reduced capacity for completion of usual activities (2.4±0.7 vs. 1.9±0.6, p=.014) compared with controls. Furthermore, the C5 group had a significantly greater cost of physical/occupational therapy, an increase of $2,078 ($4,386±$2,801 vs. $2,307±$1,907, p=.013). There were no significant differences between groups in the cost of hospital stay, surgery, or other direct or indirect costs. Overall, there was a significantly greater cost ($1,918) for the C5 palsy group compared with the control group ($7,584±$3,992 vs. $5,666±$2,359, respectively, p=.038).ConclusionsThis study represents the first quantification of the impact of C5 palsy on patients' quality of life and the associated costs for care. We found that C5 palsy adds a significant burden on patients' quality of life and presents a financial burden to the health-care system.Copyright © 2014 Elsevier Inc. All rights reserved.

25 keywords...

hide…