Brachial plexus avulsion injury repairs with nerve transfers and nerve grafts directly implanted into the spinal cord yield partial recovery of shoulder and elbow movements.

Abstract

Complete avulsion of the brachial plexus is a devastating injury that primarily affects young adults. The current treatment is based on nerve transfers, which yield very limited recovery. In this study, brachial plexus injuries were repaired with nerve transfers and nerve grafts directly implanted into the spinal cord. Eight patients with complete brachial plexus avulsion injuries were surgically treated. Roots or target nerves of the brachial plexus were repaired with peripheral nerve grafts directly implanted into the spinal cord and with extraplexal nerve transfers. Muscle reinnervation was observed for six patients who received spinal implants. Among those patients, one recovered M4 muscle power. Reinnervation was observed only in proximal upper limb muscles. Muscle reinnervation through nerve grafts directly implanted into the spinal cord was demonstrated. It seems that the combination of intra- and extradural neurotizations improves the proximal muscle function results. However, the extent of this improvement is limited and, in our opinion, does not justify the use of spinal implants.