Modified C-7 neurotization in the treatment of brachial plexus avulsion injury

Clinical article

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Object

Contralateral C-7 transfer is often used in patients with brachial plexus avulsion injury. Traditionally, the contralateral C-7 root has only been transferred to a single nerve, such as the median or radial nerve. In this study, the authors aimed to evaluate the efficacy of contralateral C-7 transfer to 2 different recipient nerves in patients with brachial plexus avulsion injuries.

Methods

Between 2004 and 2008, 10 patients with brachial plexus root avulsions underwent nerve reconstruction using a modified C-7 neurotization technique. In this procedure, the contralateral C-7 root was transferred via vascularized ulnar nerve grafts to both the musculocutaneous nerve and the median nerve on the affected side.

Results

The strength of the biceps muscles increased to M3 or M4 in 6 patients and to M2 in 2 patients. The median nerve transfers led to regained motor function and strength of the wrist and finger flexors with improvement to M3 in 5 patients. Seven patients showed notable gains of sensory function (≥ S3).

Conclusions

Contralateral C-7 transfer to 2 different recipient nerves is a feasible and efficient approach in patients with brachial plexus avulsion injuries when the donor nerve is limited.

Abbreviations used in this paper: MRC = Medical Research Council; SSEP = somatosensory evoked potential.

Article Information

Address correspondence to: Chunlin Hou, M.D., Department of Orthopedic Surgery, Changzheng Hospital, The Second Military Medical University, Fengyang Road 415, Shanghai 200003, People's Republic of China. email: haodonglin@hotmail.com.

Please include this information when citing this paper: published online July 15, 2011; DOI: 10.3171/2011.6.JNS101604.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    A 2-stage method was adopted to connect the contralateral C-7 nerve root to the affected brachial plexus. Upper: The ipsilateral ulnar nerve is severed at the level of the wrist and dissected proximally, transferred via a pectoral subcutaneous tunnel to the contralateral side, and coapted to the contralateral C-7 nerve root. Lower: Contralateral C-7 transfer to the musculocutaneous nerve and the medial part of the median nerve by vascularized ulnar nerve grafting. MCN = musculocutaneous nerve; Med. N = median nerve; Ul. N = ulnar nerve. Printed with permission from Dr. Hou.

  • View in gallery

    Photograph of a patient with total root avulsions of the right brachial plexus, showing good recovery (M3) of the biceps and the wrist and finger flexors after transfer of the contralateral C-7 to the musculocutaneous nerve and the medial part of the median nerve.

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