Bypass Coaptation Procedures for Cervical Root Avulsion

Abstract

In the past, patients with cervical spinal nerve root avulsions were resigned to accept a natural crippling from upper extremity neurological deficits. Recently, bypass coaptation procedures have resulted in functional return of denervated muscles after such avulsions, much to the appreciation of patients. Presented are 12 patients with avulsion of cervical spinal nerve roots that form either the brachial plexus upper trunk (n = 7), lower trunk (n = 1), or all three trunks (n = 4). The patients underwent the new bypass coaptation procedures with complete or partial return of motor and sensory function, which otherwise would be totally nonfunctional. The most dramatic results were noted in those patients who underwent operations within 6 weeks of injury. The results of these procedures offer patients a valid therapeutic modality for an enhanced quality of life after cervical nerve root avulsion.

Técnicas de reconstrucción nerviosa en cirugía del plexo braquial traumatizado (Parte 1): Transferencias nerviosas extraplexuales

“…En 1991, Yamada et al 71 , describieron esta transferencia para lesiones del plexo braquial con avulsión de raíces. Los ramos primarios anteriores de las raíces cervicales C3 y C4 (ambos o solo uno de ellos), inmediatamente distales a la De hecho, esta técnica es una variante del procedimiento descrito originalmente por Brunelli y Monini 15 años antes 8 .…”

“…Usando una variante de esta técnica, Yamada et al, publican una serie de 12 pacientes a los que se realizó una transferencia de raíces C3-C4 a otros nervios, para reinervar diferentes músculos 71 . Nueve pacientes presentaron una fuerza BMRC 3 o superior en algunos de los mús-culos explorados.…”

Prof. Shokei Yamada: An international neurosurgeon, regarded as father figure for adult tethered cord syndrome management and dedicated life for the advancement of intracranial arteriovenous malformation surgery

“…Skokie Yamada M.D., Ph.D. (January 2, 1926, to August 31, 2017), Emeritus Professor and Chairman, Department of Neurosurgery, Loma Linda University School of Medicine, is a much-respected teacher, mentor, researcher, and friend to younger generation of students and fellows in neurosurgery. He did extensive innovations, master expert, and research work in the field of adult tethered cord syndrome,[1] was regarded as the preeminent authority for adult tethered cord syndrome treatment, and also dedicated his life for the advancement of surgery of brachial plexus injury[2345] and arteriovenous malformation (AVM). [678]…”

“…Prof. Yamada published about 175 scientific articles in the prestigious international journals and many book chapters. [123456789] He was regarded as the authority for adult tethered cord syndrome and he wrote a famous book titled “Tethered Cord Syndrome.” In addition, he was the editor of “AVMs in Functional Areas” and also served on the Editorial Board of Journal of Neurological Research. He was credited for editing three books related to tethered cord syndrome and AVM.…”

“…Further, he advocated the coaptation to the lower trunk for Klumpke palsy due to C8 and T1 root avulsion in children to regain power and useful function of small hand muscle function and he was awarded the blue ribbon at the meeting of Spine and Peripheral Nerve Section, American Association of Neurological Surgeons. [1234]…”