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An Electrophysiological Study on Function of C7 Nerve Root and Clinical Implication in Ipsilateral C7 Transfer For C5-C6 Avulsion of the Brachial Plexus
Jianguang Xu, MD, PhD; Lei Xu, MD, PhD; Junjian Jiang, MD, PhD; Shihui Gu, MD, PhD; Li Chen, MD, PhD
Huashan Hospital, Fudan University, Shanghai, China
Objectives: For brachial plexus lesions with incomplete nerve root avulsion, various neurotization techniques have been advocated. However, there are few reports in the literature of ipsilateral C7 transfer. To identify the function of ipsilateral C7 nerve root, our previous studies have suggested that the long head of triceps and latissimus dorsi were mainly innervated by C7 (no published). Here, we analysed retrospectively the relationship between function and transfer of C7 for C5-C6 avulsion of the brachial plexus.
Method: 20 patients sought surgical treatment for C5-C6 avulsion of the brachial plexus at our medical institution between July 2008 to December 2009. Of the patients, 18 were men and 2 were women. Their ages at surgery ranged from 19 to 56 years, with a mean of 32.4 years. The operative delay was from 2 to 7 months (mean, 4 months). During surgery procedure of C7 transfer, the compound muscle action potential (CMAP) were recorded from long head of triceps and latissimus dorsi by stimulating C7. 15 patients (group A) who were no spontaneous electrical activity on latissimus dorsi or long head of triceps. Other 5 patients (group B) with spontaneous electrical activity on latissimus dorsi or long head of triceps. At a mean follow-up of 14 months, shoulder abduction and elbow flexion were evaluated.
Results: 14 of 20 patients (70%) had 30-45 degrees of shoulder abduction and 80 degrees of elbow flexion. Strength of the biceps, deltoid and infraspinatus was M3+ or better (15/20;75%). 14 of 15 patients in group A (93%)were more likely to regain the motor function (biceps, deltoid and infraspinatus was M3+ or better )than 1 of 5 patients in group B (20%). All patients had different degrees of tingling sensations in the ipsilateral radial three fingers at 3 to 4 weeks after the surgery. Strength of latissimus dorsi and triceps reduced slightly in 3 months.
Conclusion: Together these results, we suggested that ipsilateral C7 should be considered to repair the upper trunk in C5-C6 avulsion of the brachial plexus. Patients without spontaneous electrical activity on latissimus dorsi or long head of triceps were significantly better recovery of shoulder abduction and elbow flexion than those who were spontaneous electrical activity on latissimus dorsi or long head of triceps.
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