Diagnosis and surgery of brachial plexus injuries

The surgical outcome of traumatic injuries of the brachial plexus (BP) depe nds on the following parameters: 1) accurate preoperative diagnosis of cerv ical root avulsion; 2) time interval between injury and surgery; 3) delicat e handling of the nerve tissue; and 4) postoperative physiologic training. This report is based on a 15-year experience in brachial plexus surgery and is supported on the grounds of two major studies. In a prospective study, the authors controlled For the reliability of preoperative radiologic diagn osis by myelo-CT and MRI scans for 40 patients, to evaluate the integrity o f the intraspinal cervical roots after brachial plexus injury. Surgical ins pection via a cervical hemilaminectomy proved the accuracy of 85 percent an d 52 percent of CT myelography and MRI, respectively. Retrospective statist ical analyses were carried out of the long-term surgical results of 54 pati ents with traumatic injuries of the BP who received a grafting procedure be tween cervical roots C5 or C6 and the musculocutaneous nerve. Patients oper ated on up to 6 months after trauma showed a better result than patients op erated on later than 12 months after trauma (p<0.05). In contrast, grafting between cervical root C5 or C6 and the use of different sural-graft sizes to reconstruct the musculocutaneous nerve demonstrated no statistically sig nificant difference in the final outcome.