Journal
JOURNAL OF NEUROSURGERY-SPINE
Volume 29, Issue 5, Pages 491-499Publisher
AMER ASSOC NEUROLOGICAL SURGEONS
DOI: 10.3171/2018.3.SPINE171251
Keywords
contralateral C7; total brachial plexus palsy; nerve transfer; donor nerve
Categories
Funding
- Priority Among Priorities of Shanghai Municipal Clinical Medicine Center [2017ZZ01006]
- National Funds for Distinguished Young Scientists [81525009]
- National Natural Science Foundation of China [81171151, 81501945, 81371389, 31500927]
- National Key R&D Program of China [2017YFC0840100, 2017YFC0840106]
- Key Clinical Program of the Ministry of Health [2010-439]
Ask authors/readers for more resources
OBJECTIVE Contralateral C7 (CC7) nerve root has been used as a donor nerve for targeted neurotization in the treatment of total brachial plexus palsy (TBPP). The authors aimed to study the contribution of C7 to the innervation of specific upper-limb muscles and to explore the utility of C7 nerve root as a recipient nerve in the management of TBPP. METHODS This was a 2-part investigation. 1) Anatomical study: the C7 nerve root was dissected and its individual branches were traced to the muscles in 5 embalmed adult cadavers bilaterally. 2) Clinical series: 6 patients with TBPP underwent CC7 nerve transfer to the middle trunk of the injured side. Outcomes were evaluated with the modified Medical Research Council scale and electromyography studies. RESULTS In the anatomical study there were consistent and predominantly C7-derived nerve fibers in the lateral pectoral, thoracodorsal, and radial nerves. There was a minor contribution from C7 to the long thoracic nerve. The average distance from the C7 nerve root to the lateral pectoral nerve entry point of the pectoralis major was the shortest, at 10.3 +/- 1.4 cm. In the clinical series the patients had been followed for a mean time of 30.8 +/- 5.3 months postoperatively. At the latest follow-up, 5 of 6 patients regained M3 or higher power for shoulder adduction and elbow extension. Two patients regained M3 wrist extension. All regained some wrist and finger extension, but muscle strength was poor. Compound muscle action potentials were recorded from the pectoralis major at a mean follow-up of 6.7 +/- 0.8 months; from the latissimus dorsi at 9.3 +/- 1.4 months; from the triceps at 11.5 +/- 1.4 months; from the wrist extensors at 17.2 +/- 1.5 months; from the flexor carpi radialis at 17.0 +/- 1.1 months; and from the digital extensors at 22.8 +/- 2.0 months. The average sensory recovery of the index finger was S2. Transient paresthesia in the hand on the donor side, which resolved within 6 months postoperatively, was reported by all patients. CONCLUSIONS The C7 nerve root contributes consistently to the lateral pectoral nerve, the thoracodorsal nerve, and long head of the triceps branch of the radial nerve. CC7 to C7 nerve transfer is a reconstructive option in the overall management plan for TBPP. It was safe and effective in restoring shoulder adduction and elbow extension in this patient series. However, recoveries of wrist and finger extensions are poor.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available