Traumatic intradural avulsion of the nerve roots of the brachial plexus, by Patrick Taylor (from the Division of Neurological Surgery, Department of Surgery, University of California at Los Angeles and the Wadsworth Veterans Administration Hospital Los Angeles). Brain 1962: 85; 579-602.

Abstract

Writing 130 years after the first description of traumatic avulsion of the spinal roots that give rise to the brachial plexus, and sometime after this complication of injury was first demonstrated by myelography, Patrick Taylor supplements an account of three cases observed personally with a review of the literature. The early work, much of it derived from obstetric practice, has established the now classic accounts of Erb–Duchenne [Wilhelm Erb (1840–1921) and Guillaume-Benjamin Duchenne de Boulogne (1806–1875)] palsy of the upper plexus, torn at the C5/C6 junction (Erb's point), and Mme Augusta Dejerine-Klumpke's (1859–1927) account of total plexus lesions that might recover to leave the ‘Erb syndrome’ from which she has concluded, based in part on experimental canine studies but later through autopsy evidence, that the presence of Horner's syndrome indicates involvement of the T1 root. But, although the literature contains around 90 cases confirmed at autopsy or surgical exploration [first performed in 1911 by the pioneering neurosurgeon Charles Frazier (1870–1936)], interest in the entity of intraspinal root avulsion in injuries of the brachial plexus has since gone into relative abeyance. Dr Taylor considers that the apparent rarity of root avulsion, as opposed to direct injury of the plexus, has been under-reported; the investigation of these cases by the axon flare test introduced by George Bonney from the Institute of Orthopaedics in London (UK) in 1959, and the findings in more recent surgical series suggest that >50% of patients with weakness of the upper arm following trauma have avulsed spinal roots and not direct injury to the brachial plexus. And his concept is that various processes and disease mechanisms occur both proximal and distal to the plexus and in its upper and lower structures, and with differential damage to motor, sensory and autonomic fibres which, taken together, determine the clinical picture …