Affiliation:
1. Hospital Governador Celso Ramos, Florianópolis; Hospital Nossa Senhora da Conceição, Tubarão; and Universidade do Sul de Santa Catarina, Centro de Ciências Biológicas e da Saúde, Tubarão, Santa Catarina, Brazil
Abstract
Abstract
OBJECTIVE
Complete avulsion of the brachial plexus is a devastating injury that primarily affects young adults. The current treatment is based on nerve transfers, which yield very limited recovery. In this study, brachial plexus injuries were repaired with nerve transfers and nerve grafts directly implanted into the spinal cord.
METHODS
Eight patients with complete brachial plexus avulsion injuries were surgically treated. Roots or target nerves of the brachial plexus were repaired with peripheral nerve grafts directly implanted into the spinal cord and with extraplexal nerve transfers.
RESULTS
Muscle reinnervation was observed for six patients who received spinal implants. Among those patients, one recovered M4 muscle power. Reinnervation was observed only in proximal upper limb muscles.
CONCLUSION
Muscle reinnervation through nerve grafts directly implanted into the spinal cord was demonstrated. It seems that the combination of intra- and extradural neurotizations improves the proximal muscle function results. However, the extent of this improvement is limited and, in our opinion, does not justify the use of spinal implants.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Neurology (clinical),Surgery
Reference17 articles.
1. Complete traumatic brachial plexus palsy;Bentolila;J Bone Joint Surg Am,1999
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3. Brachial plexus repair by peripheral nerve grafts directly into the spinal cords in rats;Bertelli;J Neurosurg,1994
4. Median nerve neurotization by peripheral nerve grafts directly implanted into the spinal cord: Anatomical, behavioural and electrophysiological evidence of sensorimotor recovery;Bertelli;Brain Res,1994
5. Brachial plexus repair by peripheral nerve grafts directly implanted into the contralateral spinal cord;Bertelli;Restor Neurol Neurosci,1997
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