Usefulness of Myelography in Brachial Plexus Injuries

Abstract

Ninety brachial plexus lesions have been examined by myelography and the results classified into six types. These were compared against the level of lesion found at exploration of the brachial plexus with electrophysiological investigations carried out during the operation. The results show that myelography can be a reliable and useful pre-exploratory measure to assess the level of the lesion of each injured root.

Spinal Cord Herniation Into Associated Pseudomeningocele After Brachial Plexus Avulsion Injury

“…The terminology used for this kind of lesion, which includes posttraumatic arachnoidal diverticula or traumatic arachnoidal diverticulum, posttraumatic spinal meningeal diverticula, extradural arachnoid cyst, pseudomeningocele, meningocele, and traumatic meningocele, is confusing (2, 3, 5-8, 12,19,22,27,30). According to myelography and CTM findings for traction avulsion injuries of the upper cervical plexus reported by several authors, the cystic lesions in the present case corresponded to a traumatic meningocele or pseudomeningocele (5,8,17,20,22,24). The term meningocele is strictly used to describe a herniation of meninges through a defect in the cranium or vertebral column, whereas the term pseudomeningocele is used only when a herniated arachnoid membrane becomes ruptured, and CSF collection occurs outside the arachnoid membrane (30).…”

“…Pseudomeningocele cases have been associated with spinal fracture, bullet injury, stab injury, and blunt trauma (2,3,6,19,25), and their formation after a brachial plexus injury has been reported to occur in up to 29% of cases, with rates of 23% (6 out of 26 roots) (5), 25% (44 out of 170 roots) (8), and 29% (107 out of 369 roots) (20) reported in various studies. Enlargement of a pseudomeningocele depends on the effect of hydrostatic pressure (30).…”

Adult brachial plexus injuries: mechanism, patterns of injury, and physical diagnosis

“…5). Nagano et al [16,17] have classified avulsion and partial avulsion patterns based on findings at the time of myelogram. The nerve roots of C5 and C6 have strong fascial attachments at the spine and are less commonly avulsed in comparison to the nerve roots of C7 through T1.…”

“…CT combined with myelography has been instrumental in helping to define the level of nerve root injury [16,22,23]. When there is an avulsion of a cervical root, the dural sheath heals with development of a pseudomeningocele.…”

Complications of Intercostal Nerve Transfer for Brachial Plexus Reconstruction

“…Most of our patients underwent intercostal nerve transfer owing to multiple nerve root avulsion injuries confirmed by computed tomography myelography, electrodiagnostic studies, and clinical examination. [17][18][19] These patients all had absence of clinical or electrical recovery or injuries that made spontaneous recovery impossible. Most patients also had nerve transfers performed to restore elbow flexion.…”