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Transdiscal C6–C7 contralateral C7 nerve root transfer in the surgical repair of brachial plexus avulsion injuries

  • Technical Note - Neurosurgical Techniques
  • Published:
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Abstract

Background

Repair of complete brachial plexus avulsion injuries may require contralateral C7 nerve root transfer. The available techniques might allow direct neuroraphy in about 50 % of cases but the others require interposing nerve grafts or humeral shaft shortening. We aimed to see if transdiscal C6–C7 contralateral C7 nerve root transfer is technically feasible and if it allows direct coaptation with the contralateral nerve roots in 100 % of cases.

Methods

In ten fresh-frozen adult cadavers, the C7 nerve root was sectioned just before it connects with other brachial plexus branches and re-routed though the C6–C7 disc space to the contralateral side. A complete C6–C7 discectomy was performed and the disc space kept open with the aid of an autologous iliac crest bone graft.

Results

Transdiscal C6–C7 contralateral C7 nerve root transfer is technically feasible. In our cadavers, it provided 5.3 ± 1.2 SDcm of extra length that allowed direct coaptation with the contralateral nerve roots, mainly C8 and T1.

Conclusions

Transdiscal C6–C7 contralateral C7 nerve root transfer is technically feasible. In our dissections it lengthens the available C7 nerve root stump by 5.3 ± 1.2SDcm. The increase was 4 cm versus the retropharyngeal route making direct coaptation with the contralateral C8 and T1 nerve roots possible.

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Acknowledgments

To the Department of Human Anatomy and Embryology of the Faculty of Medicine of the Valencia University, particularly to the laboratory curators Lucia and Carmina and to Dr. Tomás Hernández Gil de Tejada.

Conflict of interest

All authors certify that we have no affiliations with or involvement in any organization or entity with any financial interest (such a honoraria; educational grants; participation in speakers’ bureaus; membership employment; consultancies; stock ownership; or other equity interest, and expert testimony or patent licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or material discussed in this manuscript.

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Authors and Affiliations

  1. Servicio de Neurocirugía, Hospital General Universitario de Valencia, Avda. Tres Cruces 3, 46015, Valencia, Spain

    Vicente Vanaclocha, Juan Manuel Herrera, Francisco Verdu-Lopez, Laurabel Gozalbes, Moises Sanchez-Pardo, Marlon Rivera, Deborah Martinez-Gomez & Juan D. Mayorga

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  1. Vicente Vanaclocha
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  2. Juan Manuel Herrera
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  3. Francisco Verdu-Lopez
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  4. Laurabel Gozalbes
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  5. Moises Sanchez-Pardo
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  6. Marlon Rivera
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  7. Deborah Martinez-Gomez
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Corresponding author

Correspondence to Vicente Vanaclocha.

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Comments

A tour de force anatomical dissection. The question is whether the significant risks of this procedure, both in terms of morbidity and even mortality, when weighed against the potential uncertain benefits, make it worthwhile to consider even doing this procedure in living human patients. Future work will determine if this procedure makes it into the clinical arena.

Michel Kliot

Illinois, USA

No clinical trial number required as it is an experimental study in cadavers

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Vanaclocha, V., Herrera, J.M., Verdu-Lopez, F. et al. Transdiscal C6–C7 contralateral C7 nerve root transfer in the surgical repair of brachial plexus avulsion injuries. Acta Neurochir 157, 2161–2167 (2015). https://doi.org/10.1007/s00701-015-2596-0

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  • DOI: https://doi.org/10.1007/s00701-015-2596-0

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