Background: Postoperative C5–C6 palsy is a recognised complication following cervical spinal surgery, resulting in significant functional impairment of shoulder and elbow function. While many cases may be managed expectantly, persistent deficits can lead to long- term disability. Brachial plexus reconstructive techniques, including nerve transfers, are well established in the setting of traumatic brachial plexopathies but are infrequently reported in the context of palsy following spinal surgery. This case series evaluates functional outcomes of brachial plexus reconstruction for persistent C5–C6 palsy after cervical spine procedures. Methods: Consecutive patients referred for postoperative C5–C6 palsy following cervical spinal surgery who underwent brachial plexus reconstruction were evaluated in detail. Reconstructive strategies were tailored to the pattern and chronicity of deficit. Muscle targets included supraspinatus, infraspinatus, deltoid, biceps and brachialis as required in each case. Outcomes reported include power measured by Medical Research Council (MRC) grading, range of joint motion and time to recovery. Results: 6 patients were included with a mean follow-up of 23 months. All patients demonstrated meaningful functional recovery, with improvement in elbow and/or shoulder function following reconstruction. Earlier referral and intervention were associated with superior motor recovery. No major donor-site morbidity was observed. Conclusion: Contemporary brachial plexus reconstructions offer a viable option for selected patients with persistent C5–C6 palsy following spinal surgery. Early recognition and timely referral increases options and may improve outcomes. These findings support the role of peripheral nerve reconstruction in managing complex postoperative cervical spinal surgery complications.