Contralateral C7 transfer via the prespinal and retropharyngeal route to repair brachial plexus root avulsion: A preliminary report

OBJECTIVE: We sought to investigate a shorter and safer route for contralateral C7 transfer. METHODS: Eight male patients were treated from December 2005 to November 2006. Their ages ranged from 22 to 43 years (average, 30 yr). Five patients had total brachial plexus avulsion. The operative delay was from 2 to 6 months (mean, 4 mo). The bilateral scalenus anterior muscles were transected before a prespinal and retropharyngeal tunnel was made. The contralateral C7 nerve root was used to repair the upper trunk or the infraclavicular lateral cord and posterior cord of the injured side via this route, with the use of direct neurorrhaphy or nerve grafting. RESULTS: The length of the harvested contralateral C7 nerve root was 4.67 +/- 0.52 cm in the first five patients. The nerve graft was 6.25 +/- 0.35 cm long for repairing supraclavicular brachial plexus and 8.56 +/- 0.45 cm long for repairing infraclavicular brachial plexus. The length of the harvested contralateral C7 nerve root averaged 6.85 cm in the last three patients, two of whom had direct neurorrhaphy to the C5 and six residual nerve roots; in the other patient, a nerve graft 3 cm in length was used. Transient contralateral sensory symptoms were reported in most patients. In all cases, shoulder abduction and elbow flexion recovered by 12 months postoperatively. CONCLUSION: Transection of the bilateral scalenus muscles can reduce the length of the nerve graft and allow the C7 nerve to be transferred more smoothly and safely through the prespinal and retropharyngeal route; this method also favors nerve regeneration and functional recovery.