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Year : 2022  |  Volume : 9  |  Issue : 2  |  Page : 128-133

Delayed C5 palsy following anterior cervical discectomy and arthroplasty – Rare presentation of two cases by an unusual phenomenon of “flosealoma”

1 Department of Neurosurgery, Aster CMI Hospital, Bengaluru, Karnataka, India
2 Department of Neuropathology, NIMHANS, Bengaluru, Karnataka, India

Correspondence Address:
Akshay Hari
Department of Neurosurgery, Aster CMI Hospital, Bengaluru, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/joss.joss_3_22

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Hemostatic agents are commonly used in neurosurgical procedures with often exceptionally low complication rates. Rarely, they may cause neurological deficits secondary to pressure effect on neurologic structures, especially when applied within narrow bony cavities. We would like to report two cases of delayed unilateral C5 palsy following anterior cervical discectomy and arthroplasty for a C5–C6 cervical disc herniation. Clinical presentation was identical in both cases, with left deltoid and bicep weakness and left-arm pain without myelopathy symptoms, although with the unusual imaging findings of a new left C4–C5 foraminal lesion. An additional emergency posterior minimally invasive cervical laminoforaminotomy was carried out to decompress the nerve. The weakness improved fully within 2 months after the second surgery. This case report highlights the importance of strong clinical suspicion for a possible lesion as a cause of postoperative C5 palsy. In this case, it was due to an unusual phenomenon where flowable hemostatic agent used in the first surgery had migrated superiorly leading to nerve compression away from the primary level.

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