Nassr, Ahmad

Background: C5 palsy is a known complication following decompressive cervical spine surgery, most often attributed to factors such as foraminal stenosis, cord drift, or traction. While its incidence after cervical procedures is well-documented, C5 palsy occurring after thoracolumbar deformity surgery has not been previously described. Case: A 70-year-old woman with a prior C2-T4 posterior cervical spinal fusion underwent thoracolumbar deformity correction with T4-pelvis fusion. Two months postoperatively, she developed sudden right deltoid and biceps weakness. Laboratory and imaging workups ruled out other pathological causes, and electromyography confirmed a new C5 palsy. She was treated with physical therapy and electrical stimulation and achieved complete recovery by 6 months post-thoracolumbar surgery. Conclusion: This case describes isolated delayed C5 palsy following thoracolumbar deformity surgery in a patient with prior cervical spine fusion 2 years earlier. Potential contributing factors include global alignment changes, altered neural tension, and intrinsic anatomic fragility of the C5 nerve root. This presentation expands the clinical context of postoperative C5 palsy and highlights the importance of monitoring for cervical neurologic deficits, even in the absence of cervical intervention. Level of Evidence: 5 – Case Report

Abstract Background Native vertebral osteomyelitis (NVO) is a life-threatening spinal infection with rising incidence and significant morbidity. Despite its growing burden, long-term data on clinical characteristics, management trends, and outcomes remain limited. Methods We conducted a 26-year multicenter retrospective cohort study of adults (≥18 years) diagnosed with NVO at Mayo Clinic sites between 1999 and 2024. Demographic, microbiologic, treatment, and outcome data were analyzed across five time periods. Predictors of treatment failure were assessed using a multivariable competing risk model. Results Among 1255 patients (median age 67; 66% male), lumbosacral involvement was most common (65%), and 21% had multilevel involvement. Pathogens were identified in 77%, most commonly Staphylococcus aureus (49%; Methicillin-susceptible S. aureus 37%, methicillin-resistant S. aureus 13%). Over time from 1999–2004 to 2020–2024, Gram-negative bacilli increased from 6% to 14% (P = .048). Comorbidities including chronic kidney disease (10% to 21%), active chemotherapy (6% to 11%), and immunosuppression (8% to 17%) increased significantly. Additionally, 1-year treatment failure declined (16% to 10%). In multivariable analysis, diabetes mellitus (subdistribution hazard ratio [sHR] 1.92, 95% CI 1.18–3.13) and multilevel involvement (sHR 1.67, 95% CI 1.17–2.38) were associated with increased incidence of treatment failure, while concurrent infections (sHR 0.57, 95% CI 0.37–0.87) and higher Charlson Comorbidity Index (sHR 0.62, 95% CI 0.43–0.90) were associated with lower failure. Conclusions This large multicenter cohort highlights increasing host complexity, shifting microbiology, and predictors of failure, emphasizing the importance of early risk stratification and tailored strategies, such as multidisciplinary evaluation and close follow-up of high-risk patients to improve outcomes.