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The Result of Contralateral C7 Spinal Nerve Transfer – a 28 Years of Experience
Margaret Woon Man Fok, FRCSED1; Chieh-Han John Tzou, MD2; David Chwei-Chin Chuang, MD3
1Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, Hong Kong; 2Division of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna, Austria; 3Division of Reconstructive Microsurgery; Dep. of Plastic & Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
Introduction: Total root avulsion of the brachial plexus remains to be a major reconstructive challenge. This study aims to evaluate the functional outcomes of brachial plexus patients with unilateral total root avulsion, who were reconstructed with CC7 spinal nerve transfer.
Materials and Methods: 168 patients who suffered from total brachial plexus palsy, and underwent reconstruction with CC7 spinal nerve transfer from 1985 to 2013 were analyzed. We then selected and analyzed the characteristics and the achievements of the 10 patients who attained the best functional outcomes.
Results: The average age was 24.8 years old. 89 patients had their dominant upper limb affected. All but 4 had more than one body part injured, 21 % of them suffered from concomitant fractures in their affected upper limbs. 40 patients had vascular injuries on their affected limbs. The average time from injury to initial nerve reconstruction was 133.5 days and the average time from initial injury to CC7 transfer was 263 days.
Neither significant nor permanent donor site morbidity was noted. The average follow-up period was 5 years.
For the 10 patients with best functional outcomes, no significant difference in their basic characteristic, their injury or their time from injury to initial nerve reconstruction was noted when compared with the other patients. A majority attained an education level of upper high school or above. They attended more follow-sessions with a longer average follow-up period of 8.2 years.
6 patients had their CC7 transfer to both median and musculocutaneous nerves while 4 patients had their CC7 transfer to their median nerve only. This ratio is comparable to the remaining patients. 8 out of 10 patients underwent more than 1 surgery, which was significantly more than the rest of the patients. All patients with CC7 transfer to musculocutaneous nerve could achieve an elbow flexion motor grading of 4. 3 out of 4 patients with CC7 transfer to median nerve only had a finger flexion of grade 3. 9 patients had a finger flexion of at least grade 2. They all had protective finger sensation. Their self-perception improved post nerve reconstruction. They also had a significant improvement in DASH and Michigan Hand score.
Conclusions: CC7 is a good treatment option for patients with total brachial plexus injuries. Patients who are young and have high education status and motivation appear to achieve better functional results in the long term.
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