Repair of ventral root avulsions of the brachial plexus: a review

Abstract

Traumatic root avulsions of the brachial plexus constitute a devastating lesion resulting in loss of function of the upper limb and carry a large emotional and socioeconomic impact. In this literature survey, the different factors involved in root avulsion are discussed in combination with various surgical techniques for repair of experimental ventral root avulsion. Until now repair of root avulsions did not generate unequivocal proof of recovery of limb function, particularly of the hand. More experimental studies are needed to assess the efficacy of several repair techniques, the optimal timing for surgery, and the complications associated with spinal cord manipulation.

Sialidase enhances spinal axon outgrowth in vivo

“…Even with this surgical option, reinnervation of muscle does not significantly restore function unless the regenerated axons establish appropriate contacts in a timely fashion, a severe limitation to clinical efficacy because of the inherently slow rate of axon regeneration. Because graft implantation carries its own risks of spinal cord injury, nerve surgeons who perform this procedure have called for optimizing functional outcomes by using neurobiological strategies to improve regeneration (6,10,46). The findings reported here, that sialidase and chondroitinase ABC each enhance axon regeneration into peripheral nerve grafts implanted into the spinal cord, provide two potential therapeutic targets to improve regeneration.…”

“…Avulsion occurs in Ͼ70% of brachial plexus injuries (7), and avulsion injury involving the ventral roots has a poor capacity for functional regeneration because of the physical separation of the axons and their nerve sheathes from their corresponding nerve cell bodies within the CNS (9). The mainstay of treatment is surgical and includes palliative surgery, such as nerve or muscle transfers, and restorative surgery, such as the implantation model used in this study (6,(10)(11)(12)(13). Two types of spinal cord implantation can restore connections between ventral horn neurons and their peripheral targets: reimplantation of the avulsed roots into the spinal cord and implantation of grafts between the spinal cord and distal nerve stumps or muscles.…”

“…Reimplantation, however, is not an option if the avulsed nerve roots retract, which commonly occurs during the delay between injury and surgery. Although grafts used in humans have ranged from artificial substrata to freezedried muscles, autologous nerve grafts are the most viable (10). Even with this surgical option, reinnervation of muscle does not significantly restore function unless the regenerated axons establish appropriate contacts in a timely fashion, a severe limitation to clinical efficacy because of the inherently slow rate of axon regeneration.…”

“…Regaining any sensorimotor function after avulsion, once thought to be impossible, was first accomplished by palliative nerve transfers to provide biceps function and shoulder stability (10). Recently, implantation of avulsed spinal nerve roots or peripheral nerve grafts into the spinal cord to bridge the CNS to the peripheral nervous system has led to functional reconnection in patients, providing a method for restorative surgical treatments (6,11,12).…”

Magnetic stimulation of the radial nerve in dogs and cats with brachial plexus trauma: A report of 53 cases

“…Brachial plexus trauma occurs when there is traction of the thoracic limb or severe abduction of the scapula (Griffiths, 1974;Steinberg, 1988). Typically, the nerve roots are more likely to be damaged than the plexus itself due to a lower capacity to stretch (Griffiths, 1974;Holtzer et al, 2002;Dewey, 2003).…”