Clinical application of ipsilateral C7 nerve root transfer for treatment of C5 and C6 avulsion of brachial plexus

Microsurgery ◽  
2003 ◽  
Vol 23 (2) ◽  
pp. 105-108 ◽  
Author(s):  
Y.-D. Gu ◽  
P.-Q. Cai ◽  
F. Xu ◽  
F. Peng ◽  
L. Chen
Keyword(s):  
Brachial Plexus ◽  
Clinical Application ◽  
Nerve Root

Analysis of human acellular nerve allograft combined with contralateral C7 nerve root transfer for restoration of shoulder abduction and elbow flexion in brachial plexus injury: a mean 4-year follow-up

2020 ◽  
Vol 132 (6) ◽  
pp. 1914-1924 ◽  
Author(s):  
Liang Li ◽  
Jiantao Yang ◽  
Bengang Qin ◽  
Honggang Wang ◽  
Yi Yang ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Nerve Root ◽  
Functional Outcomes ◽  
Elbow Flexion ◽  
Shoulder Abduction ◽  
Allograft Reconstruction ◽  
Acellular Nerve Allograft ◽  
The Mean ◽  
Monofilament Test

OBJECTIVEHuman acellular nerve allograft applications have increased in clinical practice, but no studies have quantified their influence on reconstruction outcomes for high-level, greater, and mixed nerves, especially the brachial plexus. The authors investigated the functional outcomes of human acellular nerve allograft reconstruction for nerve gaps in patients with brachial plexus injury (BPI) undergoing contralateral C7 (CC7) nerve root transfer to innervate the upper trunk, and they determined the independent predictors of recovery in shoulder abduction and elbow flexion.METHODSForty-five patients with partial or total BPI were eligible for this retrospective study after CC7 nerve root transfer to the upper trunk using human acellular nerve allografts. Deltoid and biceps muscle strength, degree of shoulder abduction and elbow flexion, Semmes-Weinstein monofilament test, and static two-point discrimination (S2PD) were examined according to the modified British Medical Research Council (mBMRC) scoring system, and disabilities of the arm, shoulder, and hand (DASH) were scored to establish the function of the affected upper limb. Meaningful recovery was defined as grades of M3–M5 or S3–S4 based on the scoring system. Subgroup analysis and univariate and multivariate logistic regression analyses were conducted to identify predictors of human acellular nerve allograft reconstruction.RESULTSThe mean follow-up duration and the mean human acellular nerve allograft length were 48.1 ± 10.1 months and 30.9 ± 5.9 mm, respectively. Deltoid and biceps muscle strength was grade M4 or M3 in 71.1% and 60.0% of patients. Patients in the following groups achieved a higher rate of meaningful recovery in deltoid and biceps strength, as well as lower DASH scores (p < 0.01): age < 20 years and age 20–29 years; allograft lengths ≤ 30 mm; and patients in whom the interval between injury and surgery was < 90 days. The meaningful sensory recovery rate was approximately 70% in the Semmes-Weinstein monofilament test and S2PD. According to univariate and multivariate logistic regression analyses, age, interval between injury and surgery, and allograft length significantly influenced functional outcomes.CONCLUSIONSHuman acellular nerve allografts offered safe reconstruction for 20- to 50-mm nerve gaps in procedures for CC7 nerve root transfer to repair the upper trunk after BPI. The group in which allograft lengths were ≤ 30 mm achieved better functional outcome than others, and the recommended length of allograft in this procedure was less than 30 mm. Age, interval between injury and surgery, and allograft length were independent predictors of functional outcomes after human acellular nerve allograft reconstruction.

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.

Surgical Reconstruction of Isolated Upper Trunk Brachial Plexus Birth Injuries in the Presence of an Avulsed C5 or C6 Nerve Root

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Kristen M. Davidge ◽  
Emily S. Ho ◽  
Christine G. Curtis ◽  
Howard M. Clarke
Keyword(s):  
Brachial Plexus ◽  
Nerve Root ◽  
Surgical Reconstruction ◽  
Birth Injuries

scholarly journals Quantitative assessment of brachial plexus MRI for the diagnosis of chronic inflammatory neuropathies

2020 ◽  
Author(s):  
Marieke H. J. van Rosmalen ◽  
H. Stephan Goedee ◽  
Anouk van der Gijp ◽  
Theo D. Witkamp ◽  
Ruben P. A. van Eijk ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Nerve Root ◽  
Interrater Reliability ◽  
Quantitative Assessment ◽  
Chronic Inflammatory Demyelinating Polyneuropathy ◽  
Diagnostic Value ◽  
Response To Treatment ◽  
Motor Neuropathy ◽  
Nerve Ultrasound ◽  
Cross Sectional

Abstract Objective This study aimed at developing a quantitative approach to assess abnormalities on MRI of the brachial plexus and the cervical roots in patients with chronic inflammatory demyelinating polyneuropathy (CIDP) and multifocal motor neuropathy (MMN) and to evaluate interrater reliability and its diagnostic value. Methods We performed a cross-sectional study in 50 patients with CIDP, 31 with MMN and 42 disease controls. We systematically measured cervical nerve root sizes on MRI bilaterally (C5, C6, C7) in the coronal [diameter (mm)] and sagittal planes [area (mm2)], next to the ganglion (G0) and 1 cm distal from the ganglion (G1). We determined their diagnostic value using a multivariate binary logistic model and ROC analysis. In addition, we evaluated intra- and interrater reliability. Results Nerve root size was larger in patients with CIDP and MMN compared to controls at all predetermined anatomical sites. We found that nerve root diameters in the coronal plane had optimal reliability (intrarater ICC 0.55–0.87; interrater ICC 0.65–0.90). AUC was 0.78 (95% CI 0.69–0.87) for measurements at G0 and 0.81 (95% CI 0.72–0.91) for measurements at G1. Importantly, our quantitative assessment of brachial plexus MRI identified an additional 10% of patients that showed response to treatment, but were missed by nerve conduction (NCS) and nerve ultrasound studies. Conclusion Our study showed that a quantitative assessment of brachial plexus MRI is reliable. MRI can serve as an important additional diagnostic tool to identify treatment-responsive patients, complementary to NCS and nerve ultrasound.

The Endoscopic Diagnosis and Possible Treatment of Nerve Root Avulsions in the Management of Brachial Plexus Injuries

1994 ◽  
Vol 19 (5) ◽  
pp. 547-549 ◽  
Author(s):  
J. J. MONSIVAIS ◽  
A. O. NARAKAS ◽  
E. TURKOF ◽  
Y. SUN
Keyword(s):  
Spinal Cord ◽  
Brachial Plexus ◽  
Nerve Root ◽  
Endoscopic Diagnosis ◽  
Spinal Cord Dorsal ◽  
Cervical Level

The spinal cord, dorsal rootlets, and ventral rootlets at the cervical level were visualized by endoscopy in ten goats. It is currently possible to visualize and document avulsed rootlets. With refinement in techniques and instruments, it will be possible to perform repairs, transfers or implantation of avulsed rootlets in the brachial plexus.

Magnetic nerve root stimulation in two types of brachial plexus injury: Segmental demyelination and axonal degeneration

1997 ◽  
Vol 20 (7) ◽  
pp. 823-832 ◽  
Author(s):  
A. Emre �ge ◽  
Ari Boyaciyan ◽  
Hakan G�rvit ◽  
Jale Yazici ◽  
Melahat De�girmenci ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Nerve Root ◽  
Axonal Degeneration ◽  
Brachial Plexus Injury ◽  
Segmental Demyelination ◽  
Root Stimulation
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