Bypass Coaptation Procedures for Cervical Nerve Root Avulsion

Yamada, Shokei; Lonser, Russell R.; Iacono, Robert P.; Morenski, John David; Bailey, Leonard L.

doi:10.1227/00006123-199606000-00018

Cited by 13 publications

(21 citation statements)

References 17 publications

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“…We learned that 1): when the donor nerve contains enough fibers, the root or trunk can be re-neurotized and integral arm function can be recovered; and 2): a poor result is better than no result. Brunelli 15 and Yamada and colleagues 18,19 used the C 3,4 nerve roots to by-pass and coapt the C 3 to C 5 and and C 4 to C 6 nerve roots, resulting in restoration of motor function in the biceps and shoulder-girdle muscles, as well as improved sensation. Yet, the physiologic features, compared to direct end-to-end neurotization, have not been illuminated.…”

Section: Discussionmentioning

confidence: 99%

C_3,4Transfer for Neurotization of C_5,6Nerve Roots in Brachial Plexus Injury in a Rabbit Model

Cao

Li²,

Yongcheng³

et al. 2003

J reconstr Microsurg

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To evaluate the root neurotization properties of extraplexal donor nerves, an avulsion injury model of brachial plexus was created and repaired by C 3,4 nerve-root transfers in the rabbit. Eighteen rabbits were divided into three groups. In Group 1 (n = 6), the right C 5,6 nerve roots were avulsed and bridged by a nerve graft taken from the femoral nerve, with C 3,4 as C 3 to C 5 and C 4 to C 6. In Group 2 (n = 6), the right C 5,6 nerve roots were cut and directly sutured end-to-end. Group 3 (n = 6) was a negative group, in which C 5,6 nerve roots were avulsed without repair. All three groups were positively controlled by the contralateral side. Postoperative behavior observation and anatomic, electrophysiologic studies were conducted 4 months later for comparison among groups. Axon existence was observed by acetylcholinesterase staining. Results showed that active motion was not found in all three groups by the end of the study. Extraplexal nerve transfer indeed was able to re-neurotize the avulsed nerve roots down to their target organ, but C 3,4 nerve transfer was weaker than direct end-to-end suture, in terms of neurotization ability. The authors conclude that "root or trunk repair" for avulsion injury of the brachial plexus is possible, provided that the donor nerve has enough fibers and the nerve regeneration ability is increased by modern moleculobiologic techniques.

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Section: Discussionmentioning

confidence: 99%

C_3,4Transfer for Neurotization of C_5,6Nerve Roots in Brachial Plexus Injury in a Rabbit Model

Cao

Li²,

Yongcheng³

et al. 2003

J reconstr Microsurg

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show abstract

“…77 In a more recent series, Yamada transferred the anterior primary rami of C3 and C4, via sural nerve grafts, to the upper trunk (in cases of C5 and C6 avulsion and a few flail arm cases) and claimed fantastic results. 78,79 Others have been unable to validate these remarkable results, demonstrating more modest success with using the motor components of cervical plexus to branches of the upper trunk when both C5 and C6 are avulsed. 23,62,80 Unlike the cervical plexus, which contains a variable number of motor fibers, 77 the phrenic nerve contains a large number of pure motor axons that allow the possibility of entire or partial transfer with success.…”

Section: C7 Spinal Nerve (Ipsilateral and Contralateral)mentioning

confidence: 99%

Nerve Transfers in Severe Obstetrical Brachial Plexus Palsy

Midha¹,

Drake²

2005

Seminars in Plastic Surgery

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Nerve transfers are increasingly utilized for repair of servere brachial plexus injuries and, indeed, are the only option when the proximal spine nerve roots have been avulsed from the spinal cord. The procedure essentially involves the coaption of a proximal foreign nerve to the distal denervated nerve, so that the latter will be reinnervated by the donated axons. The primary goal of surgery in the severe obstetrical brachial plexus palsy case is to return proximal arm function, particularly elbow flexion and a stable, dynamic shoulder that can abduct and externally rotate. Neural input should thus be directed first to the biceps via the musculocutaneous nerve or its branches, and next to reconstructing the suprascapular nerve. Unlike an adult with a complete palsy, where the return of distal hand function is virtually impossible, the infant has better odds of successful reinnervation of the hand. If donor nerve sources are available following repair of the musculocutaneous and suprascapular nerves, grafts can be directed to the radial (for wrist and finger extention) and median (for elbow and finger flexion and critical hand sensibility) nerves. Recovery of intrinsic hand muscle function from plexus reconstruction in the global severe palsy case is not a realistic possibility at present. Cortical plasticity, which is likely more prevelent in the baby than the adult, appears to play an important physiological role in the functional recovery of the reinnervated muscles following nerve transfers.

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“…Encouraging results with the use of the cervical plexus as donor nerves have also been reported by Yamada (Table 2). 82,84 Yamada et al reported the results of 11 patients who underwent coaptation of the C3 and C4 anterior rami to the upper trunk. 84 Nine of these patients achieved at least antigravity strength of elbow flexion, with the most dramatic results noted in those who underwent the operation within 6 weeks of injury.…”

Section: Cervical Plexusmentioning

confidence: 99%

“…82,84 Yamada et al reported the results of 11 patients who underwent coaptation of the C3 and C4 anterior rami to the upper trunk. 84 Nine of these patients achieved at least antigravity strength of elbow flexion, with the most dramatic results noted in those who underwent the operation within 6 weeks of injury. 84 The cervical plexus can also be utilized to perform neurotization of the long thoracic nerve to provide sufficient serratus anterior strength in the approximately 15% of patients with brachial plexus avulsion injury who demonstrate denervation of that muscle.…”

Section: Cervical Plexusmentioning

confidence: 99%

Evaluation and Surgical Repair of Brachial Plexus Injuries

Gabriel¹,

Villavicencio²,

Friedman³

2001

Seminars in Neurosurgery

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Bypass Coaptation Procedures for Cervical Nerve Root Avulsion

Cited by 13 publications

References 17 publications

C_3,4Transfer for Neurotization of C_5,6Nerve Roots in Brachial Plexus Injury in a Rabbit Model

C_3,4Transfer for Neurotization of C_5,6Nerve Roots in Brachial Plexus Injury in a Rabbit Model

Nerve Transfers in Severe Obstetrical Brachial Plexus Palsy

Evaluation and Surgical Repair of Brachial Plexus Injuries

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Bypass Coaptation Procedures for Cervical Nerve Root Avulsion

Cited by 13 publications

References 17 publications

C3,4Transfer for Neurotization of C5,6Nerve Roots in Brachial Plexus Injury in a Rabbit Model

C3,4Transfer for Neurotization of C5,6Nerve Roots in Brachial Plexus Injury in a Rabbit Model

Nerve Transfers in Severe Obstetrical Brachial Plexus Palsy

Evaluation and Surgical Repair of Brachial Plexus Injuries

Contact Info

Product

Resources

About

C_3,4Transfer for Neurotization of C_5,6Nerve Roots in Brachial Plexus Injury in a Rabbit Model

C_3,4Transfer for Neurotization of C_5,6Nerve Roots in Brachial Plexus Injury in a Rabbit Model