gms | German Medical Science

Objective: The incidence of OBPL is about 0.5–2.5‰. The natural history reveals a wide variety of spontaneous functional restoration from 7–80%. Which treatment is best for the individual case is therefore a crucial decision. In cases of missing or prolonged improvement of motor function, microsurgical intervention is a treatment option with a high potential for functional recovery.

Methods: 70 children with OBPL were included in this restrospective study. All children were clinically examined after birth and thereafter on a regular basis using the Gilbert and Raimondi (G&R) scores. 48 children improved consistently and showed good recovery of biceps function after 3 months with an ongoing recovery thereafter. Because of the failure of spontaneous neurological improvement despite intensive physical therapy, 22 children were operated 6-8 months after birth. In every child scheduled for operative therapy, cervical myelography and CT scans were performed prior to surgery. The operated children were re-examined on a regular basis every 3 months. Final evaluation was 26.5 months after surgery on the average.

Results: Myelography and post myelopraphic CT scans depicted 16 pseudomeningoceles. Only 4 (25%) were confirmed during surgery. In 13 celes myelography was false positive, in 1 false negative. Using the G&R scores, the operated children with upper OBPL (C5 and C6 roots, n=7) improved from 0.28 to 3.87 (shoulder), from 2.33 to 4.47 (elbow) and form 3.85 to 4.28 (hand). For combined OBPL (C5 – D1 roots) the scores improved from 0 to 2.34 (shoulder), from 1.39 to 3.08 (elbow) and form 0.89 to 2.33 (hand). One child with lower OBPL improved from 0 to 4 (shoulder), from 2 to 4 (elbow) and form 2 to 3 (hand). There were no postoperative surgical complications like hematoma or infection.

Conclusions: Out of 70 children, 22 were operated after careful examination and demonstration of failed spontaneous recovery (31.4%). There were no major surgical complications. The recovery of motor function after surgery showed significant improvement. Especially the upper OBPL showed good results but hand function also showed good improvement in combined and lower OBPL. Myelography is useful for preoperative planning of reconstruction, but due to a high rate of false positive findings, the involved roots must be carefully examined and dissected during surgery. In summary microsurgical reconstruction of OBPL is a safe and effective treatment in carefully selected children.