Surgical treatment for total root avulsion type brachial plexus injuries by neurotization: A prospective comparison study between total and hemicontralateral C7 nerve root transfer

Abstract

Purpose: We conducted a clinical study to evaluate the effects of neurotization, especially comparing the total contralateral C7 (CC7) root transfer to hemi-CC7 transfer, on total root avulsion brachial plexus injuries (BPI). Methods: Forty patients who received neurotization for BPI were enrolled in this prospective study. Group 1 (n = 20) received hemi-CC7 transfer for hand function, while group 2 (n = 20) received total-CC7 transfer. Additional neurotization included spinal accessory, phrenic, and intercostal nerve transfer for shoulder and elbow function. The results were evaluated with an average of 6 years follow-up. Results: Group 1 had fewer donor site complications (15%) than group 2 (45%); group 2 had significantly better hand M3 and M4 motor function (65%) than group 1 (30%; P = 0.02). There was no difference in sensory recovery. Significantly, better shoulder function was obtained by simultaneous neurotization on both suprascapular and axillary nerves. Conclusions: Total-CC7 transfer had better hand recovery but more donor complications than hemi-CC7. Neurotization on both supra-scapular and axillary nerves improved shoulder recovery. © 2013 The Authors. Microsurgery published by Wiley Periodicals, Inc. Microsurgery 34:91–101, 2014.

A Systematic Review of Outcomes of Contralateral C7 Transfer for the Treatment of Traumatic Brachial Plexus Injury

“…Fifteen patients in 3 studies did not have complete recovery from sensory abnormality. 9, 15, 30 Eleven patients in 6 studies with motor weakness did not recover by the latest follow-up period. 9, 12, 13, 16, 30, 34 Among them, 3 patients sustained severe motor deficits including loss of hand muscle functions; 2 patients required subsequent tendon transfer.…”

“…Among 27 included studies, there was one prospective randomized control trial; 9 all others were retrospective studies. 7, 10–34 The studies were divided into whole CC7 (n=16) and partial CC7 (n=11).…”

“…7, 10–34 The studies were divided into whole CC7 (n=16) and partial CC7 (n=11). Three studies reported two CC7 types, 9, 12, 25 and the CC7 type was not available in 3 studies 10, 13, 33 that were only included in overall study (Table 2). …”

“…9, 12, 13, 15, 16, 30, 34 Seven of them had both sensory and motor function deficits. Fifteen patients in 3 studies did not have complete recovery from sensory abnormality.…”

“…9, 12, 13, 16, 30, 34 Among them, 3 patients sustained severe motor deficits including loss of hand muscle functions; 2 patients required subsequent tendon transfer. 9, 12, 30 Clinical symptoms of all 19 patients are presented in Table 4.…”