Methods: A total of 31 C5 motor palsies in 26 patients were included in this case series. Patients underwent 16 anterior cervical discectomy and fusions, six laminoplasties, and four laminectomies with fusion procedures. Visual Analog Scale (VAS) pain scores, Neck Disability Index (NDI), and strength scores were recorded during pre- and postoperative follow-up visits. Statistical analysis was conducted using Fisher’s exact test and a paired t-test with analysis of variance. Results: The mean preoperative motor strength grades for the deltoid and biceps were 2.1 and 3.2, respectively. At final follow-up, mean deltoid and bicep motor grades had significantly improved compared to preoperative values (p <0.0001, p <0.0001, respectively). Significant improvements were also observed in NDI scores (39.3 to 26.7, p <0.05) and VAS pain scores (4.42 to 2, p <0.05) at final follow-up. Conclusions This study is the first to report outcomes of surgical management for spontaneous, de novo C5 motor palsies. Following surgical intervention, patients experienced favorable recovery of deltoid and bicep motor strength. Both anterior and posterior approaches resulted in successful motor recovery when appropriately selected based on preoperative imaging and surgical planning.