Partial Ipsilateral C7 Transfer to the Upper Trunk for C5-C6 Avulsion of the Brachial Plexus

Authors: Yin H, Su J, Xu WD, Xu L, Xu JG, Gu YD

Source: Neurosurgery. 2011 Nov 8

Yin et al. from Shanghai developed ipsilateral partial C7 root transfer in treating C5-C6 avulsion.

The authors state that: "Ipsilateral whole C7 root transfer has been reported in treating C5-C6 avulsion. To minimize donor deficits, partial ipsilateral C7 (PIC7) transfer was developed".

The authors prospectively studied eight young adults with C5-C6 avulsion. Five patients (Group A) who also had spinal accessory nerve (SAN) injury underwent PIC7 transfer to the upper trunk. The other three patients (Group B) without SAN injury underwent a combination of PIC7 to the upper trunk and the SAN to the suprascapular nerve (SSN). Postsurgical evaluations including donor deficits, functional recovery and co-contraction of the muscles were performed one week later and then at intervals of 3 months.

The authors found that: "After a mean period of 39.2 months, all subjects were found to have gained elbow flexion of 110-150° with muscle strength of M4-5. The patients in Group B achieved external rotation of 60-70° at M3-4, and two achieved shoulder abductions approaching 180° at M4. The patients in Group A showed no active external rotation and shoulder abduction of 25-50° at M2-3. The temporary deficits caused by PIC7 transfer disappeared in all subjects within the first 3 months. Co-contraction of the latissimus dorsi against the deltoid was recorded in Group A but not in Group B".

Conclusion of the authors: "ipsilateral partial C7 root transfer, when combined with SAN transfer to SSN as a novel approach, is a safe, easy and efficacious surgical procedure for patients with simple C5-C6 avulsion".

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