Abstract
This prospective multicenter study examined the incidence, risk factors, and recovery course of C5 palsy after surgery for cervical ossification of the posterior longitudinal ligament in 482 patients treated at 28 institutions between 2015 and 2017. C5 palsy was defined as a postoperative decline of at least one grade in deltoid MMT strength. Overall, 6.0% of patients developed C5 palsy, with notable variation by surgical procedure: 4.0% after anterior decompression and fusion, 4.6% after laminoplasty, and 11.8% after posterior decompression and fusion. Nearly half of the affected patients developed symptoms on the day of surgery, and deltoid strength dropped from a mean of 4.7 preoperatively to 2.3 at onset. Over the following two years, 81% of patients regained their preoperative motor function. Better outcomes were observed in younger individuals and in those without concurrent biceps brachii weakness, whereas older patients and those with multimuscle involvement showed less favorable recovery. These findings clarify the expected clinical course of C5 palsy after OPLL surgery and highlight patient factors that may help guide prognosis and perioperative counseling.
Data availability
The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request.
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The authors express their profound gratitude to all the institutions that have cooperated with them, proof-readers and editors.
Funding
This study was supported by Japan Agency for Medical Research and Development and Japanese Health Labour Sciences Research Grant (grant no. 23ek0109541h0003).
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S.E. managed the data and contributed to data analysis and manuscript writing. T.Y. supervised the study. T.H., K.S., K.K., S.T., Y.M., K.Y., H.O., K.W., K.K., M.K., A.K., T.F., S.M., N.N., Y.N., Y.O., K.A., H.N., T.E., K.M., H.N., K.M., M.M., T.K., K.Y., T.B., S.K., T.O., M.T., H.M., S.F., H.K., H.K., N.N., H.T., S.I., Y.K., K.T., M.N., M.M., and M.Y. contributed to data collection and guidance on the manuscript content. All authors read and commented on previous versions of the manuscript, and approved the final manuscript.
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Egawa, S., Hirai, T., Sakai, K. et al. Incidence and prognostic factors of postoperative C5 palsy after cervical OPLL surgery: a nationwide prospective multicenter study. Sci Rep (2026). https://doi.org/10.1038/s41598-026-45807-4
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DOI: https://doi.org/10.1038/s41598-026-45807-4
