Contralateral C7 Transfer via the Prespinal and Retropharyngeal Route to Repair C6 and C8 for Patients With Total Brachial Plexus Root Avulsion

Abstract

Objective: We sought to investigate a new way of neurotization to reconstruct the flexion of elbow, wrist, and finger of patients with total brachial plexus root avulsion. Methods: Nine patients were treated from October 2008 to November 2009. Their ages ranged from 6 to 45 years (average, 25 years). The operative delay was from 4 to 16 weeks (mean, 9 weeks). All patients had total brachial plexus avulsion, confirmed by intraoperative finding and electromyography. After a prespinal and retropharyngeal tunnel was made, the contralateral C7 nerve root was transferred to repair both C6 and C8 of the injured side via this route, with nerve grafting. The nerve graft was 5.61 ± 1.91 cm long for repairing C6 and 5.78 ± 2.32 cm long for repairing C8. Results: In 2 cases, we found early functional recovery of elbow flexion at the seventh month postoperatively. In all cases, we found recovery of elbow flexion at the 12th month postoperatively, and recovery of wrist and finger flexion at the 15th month postoperatively. Conclusion: This way of neurotization shortens the distance of nerve regeneration, and the nerve fibers of contralateral C7 are fully used to reconstruct the flexion of elbow, wrist, and finger. Results of follow-up show this method favors nerve regeneration and functional recovery.