ABSTRACT
The surgical outcome of traumatic injuries of the brachial plexus (BP) depends on
the following parameters: 1) accurate preoperative diagnosis of cervical root avulsion;
2) time interval between injury and surgery; 3) delicate 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
diagnosis by myelo-CT and MRI scans for 40 patients, to evaluate the integrity of
the intraspinal cervical roots after brachial plexus injury. Surgical inspection via
a cervical hemilaminectomy proved the accuracy of 85 percent and 52 percent of CT
myelography and MRI, respectively. Retrospective statistical analyses were carried
out of the long-term surgical results of 54 patients with traumatic injuries of the
BP who received a grafting procedure between cervical roots C5 or C6 and the musculocutaneous
nerve. Patients operated on up to 6 months after trauma showed a better result than
patients operated 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
significant difference in the final outcome.
