A Clinical Analysis of Repairing the Whole Brachial Plexus Nerve Root Avulsion by Transferring C7 Nerve Root from the Uninjured Side

Traumatic brachial plexus complete avulsions and the subsequent formation of pseudomeningoceles are a well-known entity that usually remains asymptomatic. Pseudomeningocele is due to the dural sleeve encasing the damaged roots and the spinal liquid that may accumulate locally or in the supraclavicular soft tissues. The pseudomeningocele, added to the associated lesion of the plexus and usually the surrounding vessels, may become difficult to manage. We describe the novel management of a traumatic pseudomeningocele using an endovascular technique.

Download Full-text

Coaptation of the anterior rami of C-3 and C-4 to the upper trunk of the brachial plexus for cervical nerve root avulsion

Journal of Neurosurgery ◽

10.3171/jns.1991.74.2.0171 ◽

1991 ◽

Vol 74 (2) ◽

pp. 171-177 ◽

Cited By ~ 33

Author(s):

Shokei Yamada ◽

Gordon W. Peterson ◽

Donald S. Soloniuk ◽

A. Douglas Will

Keyword(s):

Brachial Plexus ◽

Nerve Root ◽

Shoulder Girdle ◽

Brachial Plexopathy ◽

Root Avulsion ◽

Cervical Nerve Root ◽

Cervical Nerve ◽

Content Type ◽

Nerve Root Avulsion ◽

Shoulder Girdle Muscles

✓ No surgical procedure has been available to repair cervical nerve root avulsion inside the spinal canal. Results with peripheral neurotization of denervated muscles have been discouraging. The authors have performed bridge-graft coaptation in three patients with C-5 and C-6 nerve root avulsion. The components of the coaptation included the anterior primary rami of C-3 and C-4 as the donor material, the entire upper trunk as the recipient, and the sural nerve graft as the bridge. This procedure resulted in restoration of motor function in the biceps and shoulder-girdle muscles and produced improved sensation. Stimulation of the C-3 and C-4 nerve roots elicited electrical responses in the biceps and deltoid muscles that indicated nerve growth through the graft and the brachial plexus into these muscles. This reconstructive procedure is effective and should stimulate development of new approaches to treatment of cervical nerve root avulsion and proximal brachial plexopathy.

Download Full-text

PLGA-PEG-PLGA hydrogel with NEP1-40 promotes the functional recovery of brachial plexus root avulsion in adult rats

PeerJ ◽

10.7717/peerj.12269 ◽

2021 ◽

Vol 9 ◽

pp. e12269

Author(s):

Wenlai Guo ◽

Bingbing Pei ◽

Zehui Li ◽

Xiao Lan Ou ◽

Tianwen Sun ◽

...

Keyword(s):

Brachial Plexus ◽

Functional Recovery ◽

Rat Model ◽

Nerve Root ◽

Axonal Regeneration ◽

Biceps Brachii ◽

Nerve Tissue ◽

Root Avulsion ◽

Avulsion Injury ◽

Nerve Root Avulsion

Adult brachial plexus root avulsion can cause serious damage to nerve tissue and impair axonal regeneration, making the recovery of nerve function difficult. Nogo-A extracellular peptide residues 1-40 (NEP1-40) promote axonal regeneration by inhibiting the Nogo-66 receptor (NgR1), and poly (D, L-lactide-co-glycolide)-poly (ethylene glycol)-poly (D, L-lactide-co-glycolide) (PLGA-PEG-PLGA) hydrogel can be used to fill in tissue defects and concurrently function to sustain the release of NEP1-40. In this study, we established an adult rat model of brachial plexus nerve root avulsion injury and conducted nerve root replantation. PLGA-PEG-PLGA hydrogel combined with NEP1-40 was used to promote nerve regeneration and functional recovery in this rat model. Our results demonstrated that functional recovery was enhanced, and the survival rate of spinal anterior horn motoneurons was higher in rats that received a combination of PLGA-PEG-PLGA hydrogel and NEP1-40 than in those receiving other treatments. The combined therapy also significantly increased the number of fluorescent retrogradely labeled neurons, muscle fiber diameter, and motor endplate area of the biceps brachii. In conclusion, this study demonstrates that the effects of PLGA-PEG-PLGA hydrogel combined with NEP1-40 are superior to those of other therapies used to treat brachial plexus nerve root avulsion injury. Therefore, future studies should investigate the potential of PLGA-PEG-PLGA hydrogel as a primary treatment for brachial plexus root avulsion.

Download Full-text

Nerve transfer in brachial plexus traction injuries

Journal of Neurosurgery ◽

10.3171/jns.1992.76.2.0191 ◽

1992 ◽

Vol 76 (2) ◽

pp. 191-197 ◽

Cited By ~ 84

Author(s):

Miroslav Samardzic ◽

Danica Grujicic ◽

Vaso Antunovic

Keyword(s):

Brachial Plexus ◽

Nerve Root ◽

Nerve Transfer ◽

Spinal Nerve ◽

Spinal Nerve Root ◽

Root Avulsion ◽

Brachial Plexus Palsy ◽

Content Type ◽

Spinal Accessory ◽

Nerve Root Avulsion

✓ Brachial plexus palsy due to traction injury, especially spinal nerve-root avulsion, represents a severe handicap for the patient. Despite recent progress in diagnosis and microsurgical repair, the prognosis in such cases remains unfavorable. Nerve transfer is the only possibility for repair in cases of spinal nerve-root avulsion. This technique was analyzed in 37 patients with 64 reinnervation procedures of the musculocutaneous and/or axillary nerve using upper intercostal, spinal accessory, and regional nerves as donors. The most favorable results, with an 83.8% overall rate of useful functional recovery, were obtained in patients with upper brachial plexus palsy in which regional donor nerves, such as the medial pectoral, thoracodorsal, long thoracic, and subscapular nerves, had been used. The overall rates of recovery for the spinal accessory and upper intercostal nerves were 64.3% and 55.5%, respectively, which are significantly lower. The authors evaluate the results of nerve transfer and analyze different donor nerves as factors influencing the prognosis of surgical repair.

Download Full-text

Additive value of magnetic resonance neurography in diagnosis of brachial plexopathy: a cross-section descriptive study

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-021-00555-5 ◽

2021 ◽

Vol 52 (1) ◽

Author(s):

Sara Mohamed Mahmoud Mabrouk ◽

Hossam Abd El Hafiz Zaytoon ◽

Ashraf Mohamed Farid ◽

Rania Sobhy Abou Khadrah

Keyword(s):

Magnetic Resonance ◽

Brachial Plexus ◽

Nerve Injury ◽

Clinical Examination ◽

Nerve Root ◽

Nerve Conduction ◽

Brachial Plexopathy ◽

Root Avulsion ◽

Magnetic Resonance Neurography ◽

Nerve Root Avulsion

Abstract Background Management of brachial plexopathy requires proper localization of the site and nature of nerve injury. Nerve conduction studies and electrophysiological studies (ED) are crucial when diagnosing brachial neuropathy but these do not determine the actual site of the lesion. Conventional MRI has been used to evaluate the brachial plexus. Still, it carried the disadvantage of the inability to provide multi-planar images that depict the entire length of the neural plexus .It might be difficult to differentiate the brachial plexus nerves from adjacent vascular structures. Magnetic resonance neurography (MRN) is an innovative imaging technique for direct imaging of the spinal nerves. Our study aims to detect the additive role of MRN in the diagnosis of brachial plexopathy over ED. Forty cases of clinically suspected and proved by clinical examination and ED—traumatic (N = 30) and non-traumatic (N = 10)—were included in our study. We compared MRN finding with results of clinical examination and ED. Results MRN findings showed that the root was involved in 80% of cases, trunks in 70% of cases affecting the middle trunk in 40% of cases, the middle and posterior cord in 25%, lateral cord in 50%, and terminal branches on 10% of cases. Ten percent of cases were normal according to MRN, and 90% had abnormal findings in the form of preganglionic nerve root avulsion in 30% of cases, mild perineural edema surrounding C6/7 nerve roots in 20%, lower brachial trunk high signal in 10%, complicated with pseudo meningocele in 20%, and with increased shoulder muscle T2 signal intensity with muscle atrophy in 10%. There were minimal differences between clinical examination finding and MRN findings, with very good agreement between electromyography and nerve conduction (p value < 0.05, with sensitivity and specificity values of 94.44% and 100%, respectively). Conclusion MRN is important in differentiating different types of nerve injuries, nerve root avulsion, and nerve edema, playing an important role in differentiating the site of nerve injury, both preganglionic or postganglionic and planning for treatment of the cause of nerve injury, either medical or surgical.

Download Full-text

Cervical nerve root avulsion in brachial plexus injuries: magnetic resonance imaging classification and comparison with myelography and computerized tomography myelography

Journal of Neurosurgery Spine ◽

10.3171/spi.2002.96.3.0277 ◽

2002 ◽

Vol 96 (3) ◽

pp. 277-284 ◽

Cited By ~ 19

Author(s):

Kazuteru Doi ◽

Ken Otsuka ◽

Yukinori Okamoto ◽

Hiroshi Fujii ◽

Yasunori Hattori ◽

...

Keyword(s):

Mr Imaging ◽

Brachial Plexus ◽

Nerve Root ◽

Brachial Plexus Injury ◽

Root Avulsion ◽

Cervical Nerve ◽

Ct Myelography ◽

Content Type ◽

Nerve Root Avulsion ◽

Fine Print

Object. The authors describe a new magnetic resonance (MR) imaging technique to demonstrate the status of the cervical nerve roots involved in brachial plexus injury. They discuss the accuracy and reproducibility of a MR imaging—derived classification for diagnosis of nerve root avulsion compared with those of myelography combined with computerized tomography (CT) myelography. Methods. The overlapping coronal—oblique slice MR imaging procedure was performed in 35 patients with traumatic brachial plexus injury and 10 healthy individuals. The results were retrospectively evaluated and classified into four major categories (normal rootlet, rootlet injuries, avulsion, and meningocele) after confirming the diagnosis by surgical exploration with or without spinal evoked potential (EP) measurements and by referring to myelography and CT myelography findings. The reliability and reproducibility of the MR imaging—based classification was prospectively assessed by eight independent observers, and its diagnostic accuracy was compared with that of traditional myelography/CT myelography classification, correlated with surgical and spinal EP findings in another 50 cervical roots in 10 patients with traumatic brachial plexus injury. Conclusions. In the retrospective study in which MR imaging and myelography/CT myelography findings involving 175 cervical roots in 35 patients were compared, the sensitivity of detection of the cervical nerve root avulsion was the same (92.9%) with both modalities. In the prospective study, interobserver reliability and intraobserver reproducibility showed that there was no statistically significant difference between MR imaging and myelography/CT myelography and that their accuracy for detecting cervical root avulsion was the same as that in the retrospective study. The overlapping coronal—oblique slice MR imaging technique is a reliable and reproducible method for detecting nerve root avulsion. The information provided by this modality enabled the authors to assess the roots of the brachial plexus and provided valuable data for helping to decide whether to proceed with exploration, nerve repair, primary reconstruction, or other imaging modalities.

Download Full-text

Computerized tomography myelography with coronal and oblique coronal view for diagnosis of nerve root avulsion in brachial plexus injury

Journal of Brachial Plexus and Peripheral Nerve Injury ◽

10.1186/1749-7221-2-16 ◽

2014 ◽

Vol 02 (01) ◽

pp. e33-e37 ◽

Cited By ~ 3

Author(s):

Hiroshi Yamazaki ◽

Kazuteru Doi ◽

Yasunori Hattori ◽

Sotetsu Sakamoto

Keyword(s):

Brachial Plexus ◽

Computerized Tomography ◽

Nerve Root ◽

Brachial Plexus Injury ◽

Root Avulsion ◽

Nerve Root Avulsion ◽

Coronal View

Download Full-text

Functional assessment of C-5 ventral rootlets by intraoperative electrical stimulation of the supraclavicular segment of the long thoracic nerve during brachial plexus surgery

Journal of Neurosurgery ◽

10.3171/jns/2008/108/3/0533 ◽

2008 ◽

Vol 108 (3) ◽

pp. 533-540 ◽

Cited By ~ 13

Author(s):

Leandro Pretto Flores

Keyword(s):

Electrical Stimulation ◽

Brachial Plexus ◽

Nerve Root ◽

Control Group ◽

Root Avulsion ◽

Long Thoracic Nerve ◽

Nerve Root Avulsion ◽

Brachial Plexus Surgery ◽

Intraoperative Electrical Stimulation ◽

Stimulation Of

Object Anatomical and functional assessment of the intradural segment of the spinal nerves is imperative in brachial plexus surgery, as the repair of postganglionic elements in the setting of a confirmed nerve root avulsion is of no benefit. None of the current techniques to detect these avulsions can provide full information that ensures the functional status of the preganglionic segment of the roots. The objective of this study was to evaluate intraoperative electrical stimulation of the supraclavicular segment of the long thoracic nerve (LTN) as a method to differentiate C-5 nerve root extraforaminal rupture from its intradural avulsion. Methods The author performed a prospective analysis of data obtained in 14 patients presenting with the loss of C-5 nerve root function secondary to traumatic brachial plexus injury. The patients were divided into 2 groups: 8 patients in whom the intradural segment of C-5 nerve root was preserved (5 cases of closed traction injuries in whom the computed tomography [CT] myelograms confirmed the integrity of C-5 root and 3 cases of open sharp injuries) and a control group of 6 patients in whom CT myelography demonstrated avulsion of the root. Results The results of the intraoperative electrical stimulation of the LTN and the surgical outcome of each patient were recorded. The LTN electrical stimulation elicited serratus anterior muscle contraction in cases in which C-5 root was not avulsed, and there were no responses in patients whose radiological evaluation had demonstrated nerve root avulsion. In those patients in whom LTN stimulation proved to be positive, the C-5 root was used as a graftable stump to the suprascapular nerve and/or to the posterior division of the superior trunk. In these cases, favorable results were observed regarding arm abduction in all cases—Medical Research Council Grades M3 (37%) and M4 (62%). In the control group, the C-5 root was not used as a donor stump and a multiple nerve transfer technique was adopted as the preferred surgical option. Conclusions Intraoperative electrical stimulation of the supraclavicular segment of the LTN is a useful complementary method to test the functional status of the C-5 ventral rootlets. If the test is positive (that is, a response is present) it is indicative of extraforaminal rupture of the root, and if negative, it is suggestive of its avulsion.

Download Full-text

The Diagnostic Value of MRI in Traumatic Brachial Plexus Injury

Journal of Hand Surgery (European Volume) ◽

10.1016/0266-7681(94)90050-7 ◽

1994 ◽

Vol 19 (1) ◽

pp. 55-59 ◽

Cited By ~ 44

Author(s):

M. OCHI ◽

Y. IKUTA ◽

M. WATANABE ◽

K. KIMOR ◽

K. ITOH

Keyword(s):

Brachial Plexus ◽

Nerve Root ◽

Brachial Plexus Injury ◽

Diagnostic Value ◽

Resonance Imaging ◽

Nerve Roots ◽

Surgical Exploration ◽

Nerve Root Avulsion ◽

Magnetic Resonance Imaging Mri ◽

The Individual

Findings in 34 patients with traumatic brachial plexus injury documented by surgical exploration and intra-operative somatosensory-evoked potentials were correlated with findings on myelography and magnetic resonance imaging (MRI) to determine whether MRI can identify nerve root avulsion. The coronal and sagittal planes were not able to demonstrate avulsion of the individual nerve roots. The axial and axial oblique planes did provide useful information to determine which nerve root was avulsed in the upper plexus, although it was difficult to clearly delineate the lower cervical rootlets. The accuracy of MRI was 73% for C5 and 64% for C6 and that of myelograpby 63% for C5 and 64% for C6. Thus, the diagnostic accuracy of MRI for upper nerve roots was slightly superior to myelography. Although its primary diagnostic value is limited to the upper nerve roots whose avulsion is relatively difficult to diagnose by myelography, MRI can provide useful guidance in the waiting period prior to surgical exploration after brachial plexus injury.

Download Full-text

Upper thoracic spinal cord herniation after traumatic nerve root avulsion

Neurosurgical FOCUS ◽

10.3171/foc.2004.16.5.20 ◽

2004 ◽

Vol 16 (5) ◽

pp. 306-309

Author(s):

Victor R. DaSilva ◽

Mubarak Al-Gahtany ◽

Rajiv Midha ◽

Dipanka Sarma ◽

Perry Cooper

Keyword(s):

Spinal Cord ◽

Nerve Root ◽

Signs And Symptoms ◽

Root Avulsion ◽

Thoracic Spinal Cord ◽

First Case ◽

Thoracic Spinal ◽

Spinal Cord Herniation ◽

Nerve Root Avulsion ◽

Upper Thoracic

✓ Transdural herniation of the spinal cord, a rare but well-documented entity, has been reported sporadically for more than 25 years as a possible cause for various neurological signs and symptoms ranging from isolated sensory or motor findings to myelopathy and Brown–Séquard syndrome. The authors report, to the best of their knowledge, the first case of upper thoracic spinal cord herniation occurring after traumatic nerve root avulsion.

Download Full-text