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.

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.

Diagnosis of root avulsions in traumatic brachial plexus injuries: value of computerized tomography myelography and magnetic resonance imaging

1997 ◽  
Vol 86 (1) ◽  
pp. 69-76 ◽  
Author(s):  
Gustavo Adolpho Carvalho ◽  
Guido Nikkhah ◽  
Cordula Matthies ◽  
Götz Penkert ◽  
Madjid Samii
Keyword(s):  
Mr Imaging ◽  
Brachial Plexus ◽  
Computerized Tomography ◽  
Root Avulsion ◽  
Imaging Studies ◽  
Ct Myelography ◽  
Content Type ◽  
Brachial Plexus Surgery ◽  
Cervical Root ◽  
Fine Print

✓ Surgical management and prognosis of traction injuries of the brachial plexus depend on the accurate diagnosis of root avulsion from the spinal cord. Myelography, computerized tomography (CT) myelography, and recently magnetic resonance (MR) imaging have become the main radiological methods for preoperative diagnosis of cervical root avulsions. Most of the previous studies on the accuracy of CT myelography and MR imaging studies have correlated the radiological findings with the extraspinal surgical findings at brachial plexus surgery. Surgical experience shows that in many cases extraspinal findings diverge from intradural determinations. Consequently, only correlation with the intradural surgical findings will allow assessment of the factual accuracy of CT myelography and MR imaging studies. In a prospective study, 135 cervical roots (C5–8) were evaluated by CT myelography and/or MR imaging and further explored intradurally via a hemilaminectomy. The accuracy of the preoperative CT myelography—based diagnosis in relation to the intraoperative findings was 85%. On the other hand, MR imaging demonstrated an accuracy of only 52%. The most common reasons for false-positive or false-negative findings were: 1) partial rootlet avulsion; 2) intradural fibrosis; and 3) dural cystic lesions. Computerized tomography myelography scans using 1- to 3-mm axial slices prove to be the most reliable method to evaluate preoperatively the presence of complete or partial root avulsion in traumatic brachial plexus injuries. Because extradural judgment of cervical root avulsion can be unreliable, accurate assessment of intraspinal root avulsion enormously simplifies the decision concerning the choice of donor nerves for transplantation and/or neurotization during brachial plexus surgery.

CT Myelography in Cervical Nerve Root Avulsion

1985 ◽  
Vol 9 (2) ◽  
pp. 275-279 ◽  
Author(s):  
Adam F. Petras ◽  
David F. Sobel ◽  
John R. Mani ◽  
Phillip R. Lucas
Keyword(s):  
Nerve Root ◽  
Root Avulsion ◽  
Cervical Nerve Root ◽  
Cervical Nerve ◽  
Ct Myelography ◽  
Nerve Root Avulsion

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.

Traumatic neuroma of the anterior cervical nerve root with no subjective episode of trauma

2002 ◽  
Vol 97 (3) ◽  
pp. 393-396 ◽  
Author(s):  
Hiroshi Nomura ◽  
Katsumi Harimaya ◽  
Hisaya Orii ◽  
Keiichiro Shiba ◽  
Takayoshi Ueta ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Upper Extremity ◽  
Nerve Root ◽  
Intractable Pain ◽  
Cervical Nerve Root ◽  
Cervical Nerve ◽  
Content Type ◽  
Traumatic Neuroma ◽  
History Of ◽  
Fine Print

✓ The authors report four cases of traumatic neuroma in the cervical nerve root in patients with no history of trauma. In one case the patient presented with intractable pain in the left upper extremity and motor paresis of the left shoulder, and in another case the patient suffered neuropathic pain in the left forearm. In both cases, magnetic resonance (MR) imaging revealed an intradural extramedullary mass lesion in the ipsilateral cervical nerve root; these MR imaging signals were similar to the intensity of the spinal cord. Intraoperatively, fusiform enlargement of the anterior cervical nerve root was detected in the subarachnoid space. Histological examination showed a meandering change of axons accompanied by mild axonal swelling and a thin myelin sheath, which are consistent with the typical pathological features of traumatic neuroma. Postoperatively, pain resolved in both cases. The authors also investigated two traumatic neuromas of the anterior cervical nerve root in autopsy cases in which there was no history of trauma and no significant neurological signs suggestive of traumatic neuroma. The authors conclude that traumatic neuroma of the anterior cervical nerve root may develop following an unnoticed minor brachial plexus injury at birth or a forgotten traction injury of the upper extremity in childhood, and the lesion may be accompanied by various case-specific clinical features.

Fast spin—echo magnetic resonance imaging for radiological assessment of neonatal brachial plexus injury

1995 ◽  
Vol 83 (3) ◽  
pp. 461-466 ◽  
Author(s):  
Paul C. Francel ◽  
Myles Koby ◽  
T. S. Park ◽  
Benjamin C. P. Lee ◽  
Michael J. Noetzel ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Mr Imaging ◽  
Brachial Plexus ◽  
General Anesthesia ◽  
Spin Echo ◽  
Fast Spin Echo ◽  
Ct Myelography ◽  
Content Type ◽  
Fast Spin ◽  
Fine Print

✓ Neurosurgical management of birth-related brachial plexus palsy involves observing the patient for a period of several months. Operative intervention is usually undertaken at 3 to 6 months of age or more in infants who have shown little or no improvement in affected muscle groups. Ancillary tests such as electromyography and nerve conduction studies are occasionally useful. No radiological study has been consistently helpful in operative planning, except for contrast computerized tomography (CT) myelography, which requires general anesthesia in infants. This is because the infant's small size exceeds the functional resolution of the imaging modalities. This report describes the use of a special sequence of magnetic resonance (MR) imaging entitled “fast spin echo” (FSE-MR). Unlike CT myelography, this technique provides high-speed noninvasive imaging that allows clinicians to evaluate preganglionic nerve root injuries without the use of general anesthesia and lumbar puncture. The utility of this technique is illustrated in three cases, two involving either infraclavicular exploration or a combination of infraclavicular and supraclavicular exposure based on FSE-MR findings. The FSE-MR imaging offers an excellent alternative to contrast CT myelography in evaluation of infants with birth-related brachial plexus injuries.

The Diagnostic Value of MRI in Traumatic Brachial Plexus Injury

1994 ◽  
Vol 19 (1) ◽  
pp. 55-59 ◽  
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.

scholarly journals A new cervical nerve root avulsion model using a posterior extra-vertebral approach in rats

2014 ◽  
Vol 08 (01) ◽  
pp. e19-e27 ◽  
Author(s):  
Takashi Noguchi ◽  
Souichi Ohta ◽  
Ryosuke Kakinoki ◽  
Yukitoshi Kaizawa ◽  
Shuichi Matsuda
Keyword(s):  
Nerve Root ◽  
Root Avulsion ◽  
Cervical Nerve Root ◽  
Cervical Nerve ◽  
Nerve Root Avulsion
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