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

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

Neurosurgical correction of upper brachial plexus birth injuries

1993 ◽  
Vol 79 (2) ◽  
pp. 197-203 ◽  
Author(s):  
John P. Laurent ◽  
Rita Lee ◽  
Saleh Shenaq ◽  
Julie T. Parke ◽  
Itzel S. Solis ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
Surgical Reconstruction ◽  
Content Type ◽  
Birth Injuries ◽  
Neurological Improvement ◽  
Children First ◽  
Fine Print

✓ The authors review the cases of 116 infants treated consecutively for birth-related brachial plexus injuries. Twenty-eight infants with upper brachial plexus lesions who showed no neurological improvement by 4 months of age were selected for early surgical reconstruction (at a mean age of 5 months). Neurological improvement of the affected arm was observed in more than 90% (p < 0.05) of the children examined longer than 9 months after brachial plexus reconstruction. A conservatively managed control subgroup of 44 children, first examined at less than 3 months of age, demonstrated neurological improvement by 4 months of age and continued to show improvement at 1 year of age. Early surgical reconstruction is recommended for infants with birth-related upper brachial plexus injury who show no neurological improvement by the age of 4 months.

OUTCOME FOLLOWING EARLY NEUROSURGICAL MANAGEMENT OF BRACHIAL PLEXUS BIRTH INJURIES: AN ANALYSIS OF 100 CONSECUTIVE CASES

2006 ◽  
Vol 37 (S 1) ◽  
Author(s):  
JAI Grossman ◽  
I Yaylali ◽  
LE Ramos ◽  
H Valencia ◽  
P Di Taranto ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Birth Injuries

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.

Histopathological nerve assessment in brachial plexus birth injuries

2021 ◽  
Author(s):  
L. Bellity ◽  
M. Le Hanneur ◽  
S. Boudjemaa ◽  
M. Bachy ◽  
Frank Fitoussi
Keyword(s):  
Brachial Plexus ◽  
Birth Injuries

Developing a Decision Aid for Youth with Brachial Plexus Birth Injuries Facing Treatment Decisions for an Elbow Flexion Contracture

PM&R ◽  
2021 ◽  
Author(s):  
Emily S. Ho ◽  
Janet A. Parsons ◽  
Kristen Davidge ◽  
Howard M. Clarke ◽  
Margaret L. Lawson ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Decision Aid ◽  
Elbow Flexion ◽  
Treatment Decisions ◽  
Flexion Contracture ◽  
Birth 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.

Brachial Plexus Birth Injuries

JBJS Reviews ◽  
2021 ◽  
Vol 9 (6) ◽  
Author(s):  
Nicholas Pulos ◽  
William J. Shaughnessy ◽  
Robert J. Spinner ◽  
Alexander Y. Shin
Keyword(s):  
Brachial Plexus ◽  
Birth Injuries
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