Cervical nerve root avulsion in brachial plexus injuries: magnetic resonance imaging classification and comparison with myelography and computerized tomography myelography

Abstract

<jats:p content-type="fine-print"><jats:italic>Object.</jats:italic> The authors describe a new magnetic resonance (MR) imaging technique to demonstrate the status of the cervical nerve roots involved in brachial plexus injury. They discuss the accuracy and reproducibility of a MR imaging—derived classification for diagnosis of nerve root avulsion compared with those of myelography combined with computerized tomography (CT) myelography.</jats:p> <jats:p content-type="fine-print"><jats:italic>Methods.</jats:italic> The overlapping coronal—oblique slice MR imaging procedure was performed in 35 patients with traumatic brachial plexus injury and 10 healthy individuals. The results were retrospectively evaluated and classified into four major categories (normal rootlet, rootlet injuries, avulsion, and meningocele) after confirming the diagnosis by surgical exploration with or without spinal evoked potential (EP) measurements and by referring to myelography and CT myelography findings. The reliability and reproducibility of the MR imaging—based classification was prospectively assessed by eight independent observers, and its diagnostic accuracy was compared with that of traditional myelography/CT myelography classification, correlated with surgical and spinal EP findings in another 50 cervical roots in 10 patients with traumatic brachial plexus injury.</jats:p> <jats:p content-type="fine-print"><jats:italic>Conclusions.</jats:italic> In the retrospective study in which MR imaging and myelography/CT myelography findings involving 175 cervical roots in 35 patients were compared, the sensitivity of detection of the cervical nerve root avulsion was the same (92.9%) with both modalities. In the prospective study, interobserver reliability and intraobserver reproducibility showed that there was no statistically significant difference between MR imaging and myelography/CT myelography and that their accuracy for detecting cervical root avulsion was the same as that in the retrospective study.</jats:p> <jats:p content-type="fine-print">The overlapping coronal—oblique slice MR imaging technique is a reliable and reproducible method for detecting nerve root avulsion. The information provided by this modality enabled the authors to assess the roots of the brachial plexus and provided valuable data for helping to decide whether to proceed with exploration, nerve repair, primary reconstruction, or other imaging modalities.</jats:p>

The Diagnostic Value of CT Myelography, MR Myelography, and Both in Neonatal Brachial Plexus Palsy

“…30,31 Its predictive value for detecting nerve root avulsions has been evaluated [32][33][34][35] and has been found to have similar 36,37 or greater 38 value compared with CT myelography in adults. MR myelography has also been evaluated in neonatal brachial plexus palsy 25,[39][40][41][42][43][44] but is yet to be widely adopted.…”

“…Similar to authors of other studies, we report predictive values by using sensitivity, specificity, and predictive values [14][15][16]18,19,[35][36][37] ; and we used clinical examination and/or findings on extradural surgical exploration as our reference standard for the detection of root avulsions. [14][15][16]18,19,35,37,45 Hemilaminectomy and opening of the dura mater would provide a more accurate reference standard and have been used to assess CT, 13,27 MR imaging, 32 and both CT and MR imaging 46 findings in adults.…”

“…[14][15][16]18,19,35,37,45 Hemilaminectomy and opening of the dura mater would provide a more accurate reference standard and have been used to assess CT, 13,27 MR imaging, 32 and both CT and MR imaging 46 findings in adults. However, the procedure involves significant morbidity and is not performed in infants for neonatal brachial plexus palsy reconstruction.…”

Operative Optionen bei Plexusverletzungen der oberen Extremität

“…Die konventionelle sowie die CTMyelographie des Halsmarks können wertvolle Informationen bezüglich einer präganglionären Verletzung des Plexus brachialis liefern [4]. Die Entwicklung einer Pseudomeningozele weist sicher auf einen Wurzelabriss hin.…”

Brachial Plexus Root Avulsion Injury with Occipital Condyle Fractures. Case Study

“…Uszko dze nie przed zwo jo we ozna cza uszko dzenie włó kien ner wo wych przed zwo jem rdze nio wym, w ka na le krę go wym lub w otwo rze mię dzy krę gowym [2][3][4]. Uszko dze nie to nie po wo du je de ge ne racji ty pu Wal le ria na i nie two rzą się ner wia ki, po nieważ ak son po zo sta je w cią gło ści z cia łem ko mór ki w zwo ju.…”