Article
The contralateral C7-transfer in multiple root avulsion injury – a preleminary outcome analysis
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Authors
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Nora Franziska Dengler
- Department of Neurosurgery, Charité – Universitätsmedizin Berlin, Berlin, Germany
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Gregor Antoniadis
- Department of Neurosurgery, Universitätsklinik Ulm am Bezirkskrankenhaus Günzburg, Günzburg, Germany
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Christian Heinen
- Department of Neurosurgery, Universitätsklinik Ulm am Bezirkskrankenhaus Günzburg, Günzburg, Germany; Department of Neurosurgery, Universitätsklinik Oldenburg, Evangelisches Krankenhaus Oldenburg, Oldenburg, Germany
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Christian Rainer Wirtz
- Department of Neurosurgery, Universitätsklinik Ulm am Bezirkskrankenhaus Günzburg, Günzburg, Germany
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Ralph König
- Department of Neurosurgery, Universitätsklinik Ulm am Bezirkskrankenhaus Günzburg, Günzburg, Germany
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Maria Teresa Pedro
- Department of Neurosurgery, Universitätsklinik Ulm am Bezirkskrankenhaus Günzburg, Günzburg, Germany
| Published: | June 8, 2016 |
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Outline
Text
Objective: A traumatic lesion of the brachial plexus is a devastating injury with serious functional restriction of the upper extremity. It concerns about 1 % of all polytrauma patients. In multiple proximal root avulsion injury axon donation for brachial plexus reconstruction is limited. In those cases a contralateral C7 nerve root transfer may be an option. At the current state, different surgical strategies are used and results of perioperative morbidity and functional patient outcome vary.
Method: 14 patients suffering unilateral traumatic multiple root avulsion injury were treated with a contralateral C7 nerve root transfer between 04/2011 and 11/2014 at the University of Ulm (Bezirkskrankenhaus Günzburg). A two-step procedure was performed. First, the brachial plexus was proximally reconstructed e.g. by neurotization of the suprascapular and musculocutaneal nerve (by phrenic or accessory nerve axon donation). Second, a selective contralateral C7 nerve root transfer for reconstruction of distal function (e.g. transfer to median, radial and / or ulnar nerve via sural or saphenous nerve interponates) was performed.
Results: In 10 patients preliminary outcome was analyzed after a median of 29 months. 50 % of patients presented with at least M3 proximal function (biceps brachii muscle). Patients experienced an improvement of sensitivity and a tinel’s sign at the wrist but distal motor function was only marginally reconstructed. 20 % of patients showed beginning signs of voluntary motor function of the hand (M2). A relief of neuropathic pain was described by 40 % of patients. Mild donor nerve morbidity was present in 50 % of all cases (40 % temporary hypesthesia of the index finger and 20 % temporary paresis of the triceps brachii muscle).
Conclusions: Voluntary hand motion that did not reach relevant function was present in 20 % of patients. However, time point of follow-up was considered too early in most cases. Additional injuries (vascular dissections, compartment syndrome) and surgical strategy may influence functional outcome.
