Modified C7 neurotization for the treatment of obstetrical brachial plexus palsy

Area of Science:

• Pediatric Surgery
• Neurosurgery
• Orthopedic Surgery

Background:

• Obstetrical brachial plexus palsy (OBPP) can lead to significant functional deficits in infants.
• Nerve reconstruction techniques are crucial for improving outcomes in OBPP.
• Contralateral C7 transfer is an underutilized but potentially effective surgical option.

Purpose of the Study:

• To evaluate the efficacy of contralateral C7 transfer to two recipient nerves in infants with OBPP.
• To assess the functional recovery of motor and sensory pathways after this neurotization technique.

Main Methods:

• A modified C7 neurotization technique was used for nerve reconstruction in 9 infants with brachial plexus root avulsions.
• The contralateral C7 root was transferred to both the musculocutaneous and median nerves on the affected side.
• Patient outcomes were assessed based on muscle strength (Medical Research Council scale) and sensory function gains.

Main Results:

• Significant improvement in biceps muscle strength (M3 or M4) was observed in 7 out of 9 patients.
• Regained motor function and strength in wrist and finger flexors (M3 or M4) occurred in 5 patients following median nerve transfer.
• All patients demonstrated notable gains in sensory function.

Conclusions:

• Contralateral C7 transfer to two recipient nerves is a feasible and efficient surgical approach for infants with OBPP.
• This technique offers a viable option for restoring both motor and sensory functions in affected infants.
• Further research can explore long-term outcomes and refine surgical protocols for OBPP management.