scholarly journals Nerve transfer in brachial plexus traction injuries

1992 ◽  
Vol 76 (2) ◽  
pp. 191-197 ◽  
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.

Mechanisms of cervical nerve root avulsion in injuries of the neck and shoulder

1974 ◽  
Vol 41 (6) ◽  
pp. 705-714 ◽  
Author(s):  
Sydney Sunderland
Keyword(s):  
Nerve Root ◽  
Spinal Nerve ◽  
Spinal Nerve Root ◽  
Root Avulsion ◽  
Cervical Nerve Root ◽  
Cervical Nerve ◽  
Content Type ◽  
Nerve Root Avulsion ◽  
New Interpretation ◽  
Fine Print

✓ The author reviews the mechanisms of traumatic spinal nerve root avulsion and proposes a new interpretation.

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

1991 ◽  
Vol 74 (2) ◽  
pp. 171-177 ◽  
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.

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

2002 ◽  
Vol 96 (3) ◽  
pp. 277-284 ◽  
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.

Updated assessment and current classification of spinal meningeal cysts

1988 ◽  
Vol 68 (3) ◽  
pp. 366-377 ◽  
Author(s):  
Michael W. Nabors ◽  
T. Glenn Pait ◽  
Edward B. Byrd ◽  
Najmaldin O. Karim ◽  
David O. Davis ◽  
...  
Keyword(s):  
Nerve Root ◽  
Spinal Nerve ◽  
Water Soluble ◽  
Type I ◽  
Spinal Nerve Root ◽  
Content Type ◽  
Spinal Meningeal Cysts ◽  
Spinal Nerve Root Fibers ◽  
Meningeal Cysts

✓ The classification of spinal meningeal cysts (MC's) in the literature is indistinct, confusing, and in certain categories histologically misleading. Based on a series of 22 cases, the authors propose a classification comprising three categories: spinal extradural MC's without spinal nerve root fibers (Type I); spinal extradural MC's with spinal nerve root fibers (Type II); and spinal intradural MC's (Type III). Although water-soluble myelography may disclose a filling defect for all three categories, computerized tomographic myelography (CTM) is essential to reveal communication between the cyst and the subarachnoid space. Communication demonstrated by CTM allows accurate diagnosis of a spinal MC and rules out other mass lesions. Magnetic resonance imaging appears useful as an initial study to identify an intraspinal cystic mass. Final characterization is based on operative inspection and histological examination for all three categories.

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