Posterior subscapular approach to the brachial plexus

Abstract

A 15-year operative experience with 105 posterior subscapular approaches to the brachial plexus in 102 patients is presented. The procedure is indicated in carefully selected cases, especially where the proximal portions of lower spinal nerves are involved. Its main advantage is proximal exposure of the plexus spinal nerves, particularly at an intraforaminal level. The indications in this series were thoracic outlet syndrome (TOS) in 51 carefully selected procedures, brachial plexus tumor involving proximal roots in 22 patients, post-irradiation brachial plexopathy in 14 cases, and proximal traumatic brachial plexus palsy in 18 patients. Thoracic outlet syndrome associated with neurological loss, recurrent TOS after a prior operation, or proximal brachial plexus surgical lesions involving the spinal nerve(s), especially at an intraforaminal level, can be approached advantageously by such a posterior subscapular approach. The technique should also be considered when prior operation, trauma, or irradiation to the neck or anterior chest wall make a posterior exploration of the plexus easier than an anterior one. Anterior exposure of the plexus is the preferable approach for the majority of lesions needing an operation, but the posterior subscapular procedure can be useful in well-selected cases.

Brachial Plexus Variations in Human Fetuses

“…The plexus may be primarily damaged (e.g., by car or motorcycle accidents, traction injuries, median sternotomies in cardiac operations, internal jugular vein cannulation, occult fractures of the first or second ribs, or gunshot wounds) or secondarily involved by disease processes that either affect the axillary contents (e.g., abnormal lymph nodes or axillary fibroses) or spread from neighboring structures such as bone, muscle, breast, or lung (2,8,10,20,22,25,28,40). The incidence of BP birth injuries varies from 1 to 2 per 1000 live births (35).…”

A modified, less invasive posterior subscapular approach to the brachial plexus: case report and technical note

“…4 A larger series of 102 patients was then published in 1993, emphasizing the variety of pathological entities that can be accessed using this surgical technique. 3 Complications in this series included winged scapula, cervical spine instability when more than 2 facets were removed, pleural tears, pneumo-or hemothorax, phrenic nerve injury palsy, or new or further damage to the brachial plexus. According to the senior author (D.G.K.…”

Die Chirurgie traumatischer Plexus brachialis-Läsionen (Aus persönlicher Sicht des Jahres 2003)

“…Der dorsale Zugang (David Kline [10,13]) Durch zweifache Laminektomie können die Wurzeln inspiziert werden, und man kann einen Ausriss direkt diagnostizieren. Es besteht aber trotzdem eine Fehlerquote von 15%.…”