Intraspinal nerve root stump repair for brachial plexus injuries:a long-term follow-up report of 10 cases

XUE Yun-hao; WANG Shu-feng; LI Wen-jun; YANG Yong

doi:10.3969/j.issn.2095-252X.2014.03.008

Abstract：Objective To report the follow-up results of 10 cases of intraspinal nerve root stump repair for brachial plexus injuries. Methods From February 2002 to June 2006, 13 patients with brachial plexus injuries were adopted. The computed tomographic myelography ( CTM ) showed there were still injured nerve roots in the anterior and posterior nerve roots. The supraclavicular brachial plexus was explored, but no corresponding proximal nerve roots with normal structures were found outside the vertebral foramen. The spinal canal was opened, and then the nerve root stumps within it were repaired by the sural nerve graft. All the patients were followed up postoperatively, and 10 of them were followed up for more than 3 years, including 4 cases of C5, 3 cases of C5-6, 1 case of C6, 1 case of C7 and 1 case of C8-T1. Results The proximal nerve roots with normal structures within the spinal canal were found in 10 cases. The nerve roots of C5 were used to repair the suprascapular nerve in 1 case, the distal C5 nerve root in 1 case, the axillary nerve in 1 case and the medial part of the median nerve in 1 case. The nerve roots of C6 were used to repair the anterior division of the superior trunk in 1 case. The nerve roots of C7 were used to repair the medial cord in 1 case. The nerve roots of C5 and C6 were used to repair the posterior division of the superior trunk and the musculocutaneous nerve respectively in 1 case. The nerve roots of C5 and C6 were used to repair the posterior division and the anterior division of the superior trunk respectively in 1 case. The nerve roots of C5 and C6 were used to repair the suprascapular nerve and the anterior division of the superior trunk respectively in 1 case. The nerve roots of C8 and T1 were used to repair the medial part of the median nerve together in 1 case. The average follow-up period was 54 months ( range;45-68 months ). The muscle strength innervated by the repair nerve was recovered to grade 3-4. The shoulder abduction and the elbow lfexion were lfexible, and special exercises were not necessary. Conclusions As to brachial plexus injuries with the nerve roots ruptured around the vertebral foramen and with the nerve roots ruptured outside the vertebral foramen but with low-quality proximal nerve roots or no reliable agreement due to the close location, the spinal canal should be opened in order to repair the injured proximal nerve roots. Hence, an ideal dynamic nerve source can be obtained for the repair of brachial plexus injuries. The repair should be performed based on the anatomical structure of the brachial plexus, and the treatment outcomes will be improved.