gms | German Medical Science

Objectives/Interrogation: To report the efficacy of transferring contralateral C7 nerve to the upper trunk via the prespinal route for neuropathic pain after total brachial plexus avulsion, and evaluate the value of this procedure for the intractable pain.

Methods: Between December 2014 and March 2016, 6 patients with refractory pain after total brachial plexus avulsion underwent the procedure of transferring CC7 nerve to the upper trunk via the prespinal route. The curative effects of this procedure for these patients were observed and studied prospectively. The questionnaire of DN-4 was used to determine if the pain in these patients was the neuropathic pain. These patients were followed up regularly, and their pains were evaluated preoperatively and postoperatively using the VAS, pain relief rate, SF-MPQ-2, territory and frequency of the pain, and HADS. The motion and sensation of the affected limb were assessed using the BMRC grading system.

Results and Conclusions: Preoperative scores of DN4 ranged from 5 to 8 in 6 patients who were followed up for a period from 24 to 38 months (average, 29.9 months). There was a descending tendency of the VAS scores over time in the six patients. The VAS scores at the 6 month, 12 month and the last time follow-up postoperatively decreased in order (P<0.05), and were significantly lower than that preoperatively (P<0.05). At the last follow-up, the curative effect of relieving pain was excellent in 4 and good in 2 patients. The total score of the SF-MPQ-2 (32.2±14.1) were significantly lower than that before operation (74.0±9.5) (P<0.05). The territory and frequency of the intractable pain decreased at the last time follow-up. The total score of the HADS was significantly lower at the last time follow-up than before operation (P<0.05). The muscle strengths of both the deltoideus and supraspinatus were grade M3 in five patients, and the mean angle of the shoulder abduction was 27.5° (20°-30°) in six patients. The muscle strengths of the biceps brachii were grade M3 or greater in five patients, and the angle of flexor elbow ranged from 0° to 130° (mean, 81.7°). The sensation in affected upper limb recovered to grade 3 in four patients and grade 2 in two patients.

Transferring CC7 nerve to upper trunk via prespinal route can significantly alleviate neuropathic pain after total brachial plexus avulsion, and this procedure is a novel and effective approach. Meanwhile, it has the advantage of recovery in both motions and muscle strengths of the affected shoulder and elbow.