Surgical technique for the treatment of C5 and C6 root avulsion

C5 and C6 root avulsion is generally treated by neurotization of musculocutaneous (M.C.) nerve by spinal accessory (S.A.) or intercostal nerve, and neurotization of supra-scapular nerve by spinal accessory. For the last few years, permanent paralysis of C5 and C6 root has been treated by neurotization of musculocutaneous nerve by one or two fascicles of the ulnar or median nerve, and axillary nerve by a few fascicles of the radial nerve. Eighteen patients with M.C. nerve paralysis were treated by end-to-end suture of one or two fascicles of the ulnar nerve. Patients were followed for 4 years. Neurotization of M.C. nerve by a few fascicles of ulnar or median nerve, and axillary nerve by two fascicles of radial nerve were performed by end-to-end suture. The operative technique is easy and results are good. However, with previous procedures, neurotization of the mentioned nerves usually requires a 6-8 cm nerve graft. With this length of graft, the recovery period is longer than with end-to-end suture. Furthermore, if more than 9 months have passed since the onset of paralysis, especially for axillary nerve, usually good functional results are not obtained. Also, both axillary and radial nerves are the branches of posterior cord, and hence CNS adaptation is more easily attained. Therefore, we recommend the use of this new technique for the treatment of C5 and C6 root avulsion, since the operative time is shorter and procedure is easier for the surgeon. Also recovery period is shorter.