Surgical reconstruction of the musculocutaneous nerve in traumatic brachial plexus injuries

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✓ Over the last 16 years, 345 surgical reconstructions of the brachial plexus were performed using nerve grafting or neurotization techniques in the Neurosurgical Department at the Nordstadt Hospital, Hannover, Germany. Sixty-five patients underwent graft placement between the C-5 and C-6 root and the musculocutaneous nerve to restore the flexion of the arm. A retrospective study was conducted, including statistical evaluation of the following pre- and intraoperative parameters in 54 patients: 1) time interval between injury and surgery; 2) choice of the donor nerve (C-5 or C-6 root); and 3) length of the grafts used for repairs between the C-5 or C-6 root and the musculocutaneous nerve.

The postoperative follow-up interval ranged from 9 months to 14.6 years, with a mean ± standard deviation of 4.4 ± 3 years. Reinnervation of the biceps muscle was found in 61% of the patients. Comparison of the different preoperative time intervals (1–6 months, 7–12 months, and > 12 months) showed a significantly better outcome in those patients with a preoperative delay of less than 7 months (p < 0.05). Reinnervation of the musculocutaneous nerve was demonstrated in 76% of the patients who underwent surgery within the first 6 months postinjury, in 60% of the patients with a delay of between 6 and 12 months, and in only 25% of the patients who underwent surgery after 12 months. Comparison of the final outcome according to the root (C-5 or C-6) that was used for grafting the musculocutaneous nerve showed no statistical difference.

Furthermore, statistical analysis (regression test) of the length of the grafts between the donor (C-5 or C-6 root) nerve and the musculocutaneous nerve displayed an inverse relationship between the graft length and the postoperative outcome.

Together, these results provide additional information to enhance the functional outcome of brachial plexus surgery.

Article Information

Address reprint requests to: Gustavo A. Carvalho, M.D., Neurochirurgische Klinik—Krankenhaus Nordstadt, Haltenhoffstrasee 41, 30167 Hannover, Germany.

© AANS, except where prohibited by US copyright law.

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Figures

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    Drawing displaying a single sural graft placed between the C-6 root and the musculocutaneous nerve (highlighted in white).

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    Scatterplot of linear regression analysis showing the relation between the time interval from trauma to surgery and the surgical result (MRC scale). For the most part, the best final results were obtained in patients who underwent surgery between 2 and 6 months postinjury.

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    Bar graph comparing the different preoperative time intervals and the achieved strength of the biceps muscle (MRC scale). Note the significantly poorer results (asterisk) in the group of patients who underwent surgery 13 months postinjury, compared with those who underwent earlier operations.

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    Bar graph comparing the functional and nonfunctional restoration of biceps strength (MRC scale) according to the different preoperative time interval. A better functional recovery was achieved in the patients who underwent surgery between 1 and 6 months postinjury, compared with those undergoing operation later.

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    Scatterplot of linear regression analysis showing better postoperative results (MRC scale) with shorter nerve grafts used for repair between the C-5 or C-6 root and the musculocutaneous nerve.

  • View in gallery

    Bar graph showing the better surgical results (MRC scale) achieved with shorter nerve grafts (1–12 cm). No statistically significant difference was found between these two groups (1–12 and > 12 cm, p < 0.05).

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