A multidisciplinary approach to the management of brachial plexus injuries: experience from the Mayo Clinic over 100 years

Shin, Alexander Y.; Bishop, Allen T.; Loosbroch, Michelle F.; Spinner, Robert J.

doi:10.1177/17531934221110733

Cited by 4 publications

(5 citation statements)

References 39 publications

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“…Patients with traumatic supraclavicular pan-brachial plexus injuries undergoing surgical reconstruction at a single institution's multidisciplinary brachial plexus clinic between 2001 and 2018 were reviewed retrospectively. 11 Patients with infraclavicular injuries or spontaneous functional recovery were excluded. Patient demographics, body mass index (BMI), speed and mechanism of injury, and Injury Severity Score (ISSs) were recorded.…”

Section: Methodsmentioning

confidence: 99%

Clinical Predictors of C5 Spinal Nerve Viability in Pan−Brachial Plexus Injuries

Asserson

Loosbrock

et al. 2023

Plastic &Amp; Reconstructive Surgery

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Backgrounds: In pan-brachial plexus injury patients, distinguishing between pre-ganglionic and post-ganglionic injuries is crucial to reconstructive planning. This study aimed to identify pre-operative factors that would accurately predict a reconstructible C5 spinal nerve. Methods: Pan-brachial plexus injury patients from a single institution between 2001 and 2018 were reviewed. Patient demographics, clinical examination, diagnostic imaging, and electrodiagnostic results were recorded. C5 viability was determined based on supraclavicular exploration and intraoperative electrophysiologic testing. Univariate analysis identified significant factors for regression analysis. Multivariable parsimonious model was created using stepwise high performance logistic regression. Results: 311 patients (mean age 29.9 years; 46 females, 265 males; Injury Severity Score 17.2) were included. 134 (43%) had a viable C5 and 50 (12%) patients had a viable C6 nerve. Intact C5 spinal nerve on CT myelogram (OR 5.4), positive Tinel’s test (OR 2.6), M ≥ 4 rhomboid (OR 1.3) or M ≥ 4 serratus anterior (OR 1.4), and rhomboid needle EMG (OR 1.8) were predictive of having a viable C5 spinal nerve. The multivariable parsimonious stepwise model (AUC 0.77) included four factors: positive Tinel’s test, intact C5 spinal nerve on CT myelogram, hemi-diaphragmatic elevation, and mid-cervical paraspinal fibrillations. Conclusions: In this cohort of pan-brachial plexus patients with major polytrauma, there was a 43% incidence of viable C5 spinal nerve. A positive Tinel’s test (OR 2.1) and intact C5 spinal nerve on CT myelogram (OR 4.9) predicted a viable C5 nerve. In contrast, hemi-diaphragmatic elevation (OR 3.1) and mid-cervical paraspinal fibrillations (OR 2.92) predicted root avulsion.

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Section: Methodsmentioning

confidence: 99%

Clinical Predictors of C5 Spinal Nerve Viability in Pan−Brachial Plexus Injuries

Asserson

Loosbrock

et al. 2023

Plastic &Amp; Reconstructive Surgery

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“…Unfortunately, many patients do not improve over time and ultimately require surgical repair of their brachial plexus injuries. 3,4,33 Surgical Repair…”

Section: Etiologymentioning

confidence: 99%

“…2 Treatment of these injuries requires a multidisciplinary approach with cooperation from numerous different medical and surgical specialties. 3 Management of closed injuries includes observation and serial examinations for 3 to 6 months as current limitations in imaging do not always allow for precise identification of the type and location of the nerve lesion. 1,4 Patients who do not have a resolution of their symptoms require surgical exploration and reconstruction.…”

mentioning

confidence: 99%

“…Functional overview of nerve branches frequently involved in brachial plexus injuries Sensation to the palmar side and dorsal tips of the lateral three and half digits, thenar eminence, and lateral palmar side of the hand Robotic Nerve Surgery Parham et al 201 many patients do not improve over time and ultimately require surgical repair of their brachial plexus injuries 3,4,33. …”

mentioning

confidence: 99%

“…2 Treatment of these injuries requires a multidisciplinary approach with cooperation from numerous different medical and surgical specialties. 3…”

mentioning

confidence: 99%

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Robotic Nerve Surgery: Brachial Plexus

Parham,

Cole,

Yim

et al. 2023

Semin Plast Surg

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Management of closed brachial plexus injuries has traditionally favored conservative approaches with lengthy intervals between initial injury and surgical reconstruction. The complex anatomy of this region often requires large incisions with extensive dissection. Recently, the use of robotic systems in plastic and reconstructive surgery has been increasing, and robot-assisted brachial plexus reconstruction is a novel application that is currently being explored. Current literature describing this application is primarily comprised of feasibility studies using animal and cadaver models, and literature describing use in human subjects is limited. Advantages demonstrated by these early studies include the reduction of physiologic tremor, 3D visualization of anatomical structures, and ergonomic positioning; this allows for increased surgical dexterity and the ability to perform minimally invasive microsurgical procedures within the confined anatomical spaces of the brachial plexus. Limitations revolve around inadequate instrumentation, large learning curves, and increased costs that restrict the ability to perform these complex microsurgical procedures reliably and efficiently. As companies continue to develop instrumentation specific to robot-assisted microsurgery, more extensive longitudinal studies outlining long-term costs, changes in operating time, and functional outcomes will be required before a conclusion about the utility of these systems in brachial plexus surgery can be made.

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