Partial Ipsilateral C7 Transfer to the Upper Trunk for C5-C6 Avulsion of the Brachial Plexus

• Published in: Neurosurgery Vol. 70; no. 5; pp. 1176 - 1182
• Main Authors: Yin, Hua-Wei, Jiang, Su, Xu, Wen-Dong, Xu, Lei, Xu, Jian-Guang, Gu, Yu-Dong
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Oxford University Press 01.05.2012; Lippincott Williams & Wilkins; Wolters Kluwer Health, Inc
• Subjects: Adult; Biological and medical sciences; Brachial plexus; Brachial Plexus Neuropathies - diagnosis; Brachial Plexus Neuropathies - surgery; Female; Humans; Male; Medical sciences; Nerve Transfer - methods; Neurosurgery; Radiculopathy - diagnosis; Radiculopathy - surgery; Spinal Nerve Roots - surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Treatment Outcome; Brachial plexus; Nerve transfer; Partial ipsilateral C7 transfer; Trunk; Nervous system diseases; Surgery; Avulsion
• ISSN: 0148-396X; 1524-4040
• DOI: 10.1227/NEU.0b013e3182400a91

Abstract BACKGROUND: Ipsilateral whole C7 root transfer has been reported in treating C5-C6 avulsion. To minimize donor deficits, partial ipsilateral C7 (PIC7) transfer was developed. OBJECTIVE: To investigate the long-term results of PIC7 transfer to the upper trunk in treating C5-C6 avulsion of the brachial plexus. METHODS: We prospectively studied 8 young adults with C5-C6 avulsion. Five patients (group A) who also had spinal accessory nerve (SAN) injury underwent PIC7 transfer to the upper trunk. The other 3 patients (group B) without SAN injury underwent a combination of PIC7 to the upper trunk and the SAN to the suprascapular nerve (SSN). Postsurgical evaluations including donor deficits, functional recovery, and co-contraction of the muscles were performed 1 week later and then at intervals of 3 months. RESULTS: After a mean period of 39.2 months, all subjects were found to have gained elbow flexion of 110 to 150° with muscle strength of M4-5. The patients in group B achieved external rotation of 60 to 70° at M3-4, and 2 achieved shoulder abductions approaching 180° at M4. The patients in group A showed no active external rotation and shoulder abduction of 25 to 50° at M2-3. The temporary deficits caused by PIC7 transfer disappeared in all subjects within the first 3 months. Co-contraction of the latissimus dorsi against the deltoid was recorded in group A but not in group B. CONCLUSION: PIC7 transfer, when combined with SAN transfer to SSN as a novel approach, is a safe, easy, and efficacious surgical procedure for patients with simple C5-C6 avulsion.