{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T05:20:38Z","timestamp":1787721638717,"version":"build-2784847793"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>C5 nerve root palsy (C5P) following cervical decompression surgery remains a frustrating complication affecting patients' quality of life. C5P primarily affects the deltoid muscle, with the biceps brachii also involved in more severe cases. This study aimed to investigate the association between the degree of biceps brachii weakness and the recovery of deltoid muscle strength in patients with severe C5P.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective cohort study of 78 patients with new-onset severe C5P following unilateral open-door laminoplasty between 2010 and 2024 was analyzed. All patients were retrospectively enrolled and underwent standardized clinical follow-up assessments at 6 and 12 months postoperatively. Univariate and multivariate logistic regression analyses were performed at the 6-month and 12-month time points to investigate the predictive value of patient characteristics, radiological features, and biceps brachii muscle strength for recovery from severe C5P.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 78 patients developed severe C5P after surgery. Univariate logistic regression analysis revealed that biceps brachii strength deficit at diagnosis, high-intensity zone (HIZ) at C3\/4 and C4\/5, and cervical kyphosis were potential risk factors for lack of deltoid strength recovery at the 6-month follow-up. At the 12-month follow-up, biceps brachii strength deficit at diagnosis, HIZ at C4\/5, and cervical kyphosis remained potential predictors of poor recovery of deltoid strength. Multivariate logistic regression identified the degree of biceps brachii strength deficit as an independent predictor of non-recovery at both 6 months (OR\u2009=\u20092.18,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001) and 12 months (Model 1: OR\u2009=\u20093.05,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001; Model 2: OR\u2009=\u20093.10,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The degree of biceps brachii strength deficit is an independent predictor of intermediate- and long-term failure of deltoid muscle recovery following severe postoperative C5P. Identifying this risk factor may provide a critical time reference for timely consideration of nerve transfer surgery in affected patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1884729","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T04:45:38Z","timestamp":1787719538000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Biceps strength drop at diagnosis is associated with deltoid strength recovery in severe postoperative C5 palsy: a retrospective cohort study"],"prefix":"10.3389","volume":"13","author":[{"given":"Yu-Fei","family":"Yuan","sequence":"first","affiliation":[{"name":"Clinical School\/College of Orthopedics, Tianjin Medical University","place":["Tianjin, China"]},{"name":"Department of Orthopedics, HanDan Center Hospital","place":["HanDan, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ye","family":"Tian","sequence":"additional","affiliation":[{"name":"Biomedical Engineering, Academic Division of Medicine, Tianjin University","place":["Tianjin, China"]},{"name":"Department of Orthpedics, The First Affiliated Hospital of Hebei North University","place":["Zhangjiakou, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peng-Fei","family":"Shen","sequence":"additional","affiliation":[{"name":"Clinical School\/College of Orthopedics, Tianjin Medical University","place":["Tianjin, China"]},{"name":"Second Department of Orthopedics, Tianjin Jizhou District People\u2019s Hospital","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Miao","sequence":"additional","affiliation":[{"name":"Department of Spine Surgery, Tianjin Hospital, Tianjin University","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,26]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"693","DOI":"10.1097\/00007632-198310000-00003","article-title":"Expansive open-door laminoplasty for cervical spinal stenotic myelopathy","volume":"8","author":"Hirabayashi","year":"1983","journal-title":"Spine"},{"key":"B2","doi-asserted-by":"publisher","first-page":"264","DOI":"10.1227\/NEU.0b013e3182305669","article-title":"A prospective, randomized trial comparing expansile cervical laminoplasty and cervical laminectomy and fusion for multilevel cervical myelopathy","volume":"70","author":"Manzano","year":"2012","journal-title":"Neurosurgery"},{"key":"B3","doi-asserted-by":"publisher","first-page":"592","DOI":"10.3171\/2019.10.SPINE19993","article-title":"Risk factors and preventive measures for C5 palsy after cervical open-door laminoplasty","volume":"32","author":"Nakajima","year":"2019","journal-title":"J Neurosurg Spine"},{"key":"B4","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1302\/0301-620X.98B1.36042","article-title":"Significant reduction in the incidence of C5 palsy after cervical laminoplasty using chilled irrigation water","author":"Takenaka","year":"2016","journal-title":"Bone Joint J"},{"key":"B5","doi-asserted-by":"publisher","first-page":"2410","DOI":"10.1007\/s00586-017-5223-3","article-title":"Factors associated with postoperative C5 palsy after expansive open-door laminoplasty: retrospective cohort study using multivariable analysis","volume":"26","author":"Tsuji","year":"2017","journal-title":"Eur Spine J"},{"key":"B6","doi-asserted-by":"publisher","first-page":"E10","DOI":"10.1097\/BRS.0000000000003205","article-title":"Impact of multifidus muscle swelling on C5 palsy after cervical laminoplasty","volume":"45","author":"Usami","year":"2020","journal-title":"Spine"},{"key":"B7","doi-asserted-by":"publisher","first-page":"110","DOI":"10.5137\/1019-5149.JTN.38560-22.2","article-title":"Preoperatively, which parameter allows US to predict the C5 palsy after cervical open-door laminoplasty?","volume":"33","author":"Uzunoglu","year":"2023","journal-title":"Turk Neurosurg"},{"key":"B8","doi-asserted-by":"publisher","first-page":"e8560","DOI":"10.1097\/MD.0000000000008560","article-title":"Incidence of C5 nerve root palsy after cervical surgery: a meta-analysis for last decade","volume":"96","author":"Wang","year":"2017","journal-title":"Medicine (Baltimore)"},{"key":"B9","doi-asserted-by":"publisher","first-page":"909","DOI":"10.1016\/j.spinee.2013.07.445","article-title":"Risk factors associated with upper extremity palsy after expansive open-door laminoplasty for cervical myelopathy","volume":"14","author":"Wu","year":"2014","journal-title":"Spine J"},{"key":"B10","doi-asserted-by":"publisher","first-page":"595","DOI":"10.1227\/NEU.0000000000000322","article-title":"Incidence and prognostic factors of c5 palsy: a clinical study of 1001 cases and review of the literature","volume":"74","author":"Bydon","year":"2014","journal-title":"Neurosurgery"},{"key":"B11","doi-asserted-by":"publisher","first-page":"2499","DOI":"10.1097\/00007632-200211150-00014","article-title":"Intraoperative neurophysiologic detection of iatrogenic C5 nerve root injury during laminectomy for cervical compression myelopathy","volume":"27","author":"Fan","year":"2002","journal-title":"Spine"},{"key":"B12","doi-asserted-by":"publisher","first-page":"457","DOI":"10.3171\/2022.11.SPINE221067","article-title":"Defining postoperative C5 palsy and recovery: a systematic review","volume":"38","author":"Deshpande","year":"2022","journal-title":"J Neurosurg Spine"},{"key":"B13","doi-asserted-by":"publisher","first-page":"E197","DOI":"10.1097\/01.brs.0000257576.84646.49","article-title":"Upper extremity palsy following cervical decompression surgery results from a transient spinal cord lesion","volume":"32","author":"Hasegawa","year":"2007","journal-title":"Spine"},{"key":"B14","doi-asserted-by":"publisher","first-page":"393","DOI":"10.1302\/0301-620X.92B3.22786","article-title":"C5 palsy after cervical laminoplasty: a multicentre study","volume":"92","author":"Imagama","year":"2010","journal-title":"J Bone Joint Surg Br"},{"key":"B15","first-page":"1009","article-title":"The effect of lateral mass slotting technique on the bony spinal canal cross-sectional area after posterior cervical unilateral open-door laminoplasty","volume":"35","author":"Shen","year":"2025","journal-title":"Chin J Spine Spinal Cord"},{"key":"B16","doi-asserted-by":"publisher","first-page":"2057","DOI":"10.1097\/00007632-199810010-00004","article-title":"Radiculopathy after laminoplasty of the cervical spine","volume":"23","author":"Uematsu","year":"1998","journal-title":"Spine"},{"key":"B17","doi-asserted-by":"publisher","first-page":"2447","DOI":"10.1097\/01.BRS.0000090833.96168.3F","article-title":"C5 palsy after decompression surgery for cervical myelopathy: review of the literature","volume":"28","author":"Sakaura","year":"2003","journal-title":"Spine"},{"key":"B18","doi-asserted-by":"publisher","first-page":"2414","DOI":"10.1097\/01.brs.0000184751.80857.3e","article-title":"Is posterior spinal cord shifting by extensive posterior decompression clinically significant for multisegmental cervical spondylotic myelopathy?","volume":"30","author":"Hatta","year":"2005","journal-title":"Spine"},{"key":"B19","doi-asserted-by":"publisher","first-page":"1795","DOI":"10.1097\/01.brs.0000225992.26154.d0","article-title":"Quantitative prediction of spinal cord drift after cervical laminectomy and arthrodesis","volume":"31","author":"Lee","year":"2006","journal-title":"Spine"},{"key":"B20","doi-asserted-by":"publisher","first-page":"1895","DOI":"10.1016\/j.spinee.2013.10.038","article-title":"Predicting C5 palsy via the use of preoperative anatomic measurements","volume":"14","author":"Lubelski","year":"2014","journal-title":"Spine J"},{"key":"B21","doi-asserted-by":"publisher","first-page":"309","DOI":"10.4103\/ortho.IJOrtho_217_17","article-title":"The use of preoperative and intraoperative pavlov ratio to predict the risk of postoperative C5 palsy after expansive open-door laminoplasty for cervical myelopathy","volume":"53","author":"Wang","year":"2019","journal-title":"Indian J Orthop"},{"key":"B22","doi-asserted-by":"publisher","first-page":"1541","DOI":"10.1302\/0301-620X.91B11.22196","article-title":"Potential risk of thermal damage to cervical nerve roots by a high-speed drill","volume":"91","author":"Hosono","year":"2009","journal-title":"J Bone Joint Surg Br"},{"key":"B23","first-page":"100","article-title":"Neurobiology of peripheral nerve injury, regeneration, and functional recovery: from bench top research to bedside application","volume":"13","author":"Sulaiman","year":"2013","journal-title":"Ochsner J"},{"key":"B24","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1016\/j.spinee.2020.10.001","article-title":"Use of electromyography to predict likelihood of recovery following C5 palsy after posterior cervical spine surgery","volume":"21","author":"Lubelski","year":"2021","journal-title":"Spine J"},{"key":"B25","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1016\/j.jocn.2021.08.007","article-title":"Timing of referral to peripheral nerve specialists in patients with postoperative C5 palsy","volume":"92","author":"Pennington","year":"2021","journal-title":"J Clin Neurosci"},{"key":"B26","doi-asserted-by":"publisher","first-page":"563","DOI":"10.3171\/2022.3.SPINE2222","article-title":"Optimal timing of referral for nerve transfer surgery for postoperative C5 palsy","volume":"37","author":"Saadeh","year":"2022","journal-title":"J Neurosurg Spine"},{"key":"B27","doi-asserted-by":"publisher","first-page":"2108","DOI":"10.1097\/00007632-200210010-00006","article-title":"Segmental motor paralysis after expansive open-door laminoplasty","volume":"27","author":"Chiba","year":"2002","journal-title":"Spine"},{"key":"B28","doi-asserted-by":"publisher","first-page":"1258","DOI":"10.1097\/01.BRS.0000065487.82469.D9","article-title":"Local kyphosis reduces surgical outcomes of expansive open-door laminoplasty for cervical spondylotic myelopathy","volume":"28","author":"Suda","year":"2003","journal-title":"Spine"},{"key":"B29","doi-asserted-by":"publisher","first-page":"1972","DOI":"10.1097\/01.BRS.0000083237.94535.46","article-title":"Preventing C5 palsy after laminoplasty","volume":"28","author":"Sasai","year":"2003","journal-title":"Spine"},{"key":"B30","doi-asserted-by":"publisher","first-page":"191","DOI":"10.1038\/sc.2013.149","article-title":"Preoperative diagnosis of the responsible level in CCM using CMAPs: comparison with SCEPs","volume":"52","author":"Funaba","year":"2014","journal-title":"Spinal Cord"},{"key":"B31","doi-asserted-by":"publisher","first-page":"358","DOI":"10.1097\/01.bsd.0000210112.09521.e3","article-title":"Investigation of motor dominant C5 paralysis after laminoplasty from the results of evoked spinal cord responses","volume":"19","author":"Kaneko","year":"2006","journal-title":"J Spinal Disord Tech"},{"key":"B32","doi-asserted-by":"publisher","first-page":"1681","DOI":"10.1007\/s00586-021-06757-9","article-title":"Preoperative electrophysiologic assessment of C5-innervated muscles in predicting C5 palsy after posterior cervical decompression","volume":"30","author":"Zheng","year":"2021","journal-title":"Eur Spine J"},{"key":"B33","doi-asserted-by":"publisher","first-page":"365","DOI":"10.3171\/2018.2.SPINE171363","article-title":"Simple presurgical method of predicting C5 palsy after cervical laminoplasty using C5 nerve root ultrasonography","volume":"29","author":"Takeuchi","year":"2018","journal-title":"J Neurosurg Spine"},{"key":"B34","doi-asserted-by":"publisher","first-page":"2441","DOI":"10.1016\/j.spinee.2025.04.006","article-title":"Biceps involvement and degree of motor deficit at diagnosis are independently predictive of timing of postoperative C5 palsy recovery","volume":"25","author":"Toci","year":"2025","journal-title":"Spine J"},{"key":"B35","doi-asserted-by":"publisher","first-page":"2893","DOI":"10.1097\/00007632-200011150-00010","article-title":"Impact of longitudinal distance of the cervical spine on the results of expansive open-door laminoplasty","volume":"25","author":"Chiba","year":"2000","journal-title":"Spine"},{"key":"B36","doi-asserted-by":"publisher","first-page":"1373","DOI":"10.1016\/S0895-4356(96)00236-3","article-title":"A simulation study of the number of events per variable in logistic regression analysis","volume":"49","author":"Peduzzi","year":"1996","journal-title":"J Clin Epidemiol"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1884729\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T04:45:48Z","timestamp":1787719548000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1884729\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,26]]},"references-count":36,"alternative-id":["10.3389\/fsurg.2026.1884729"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2026.1884729","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,26]]},"article-number":"1884729"}}