Factors Affecting C5 Viability and Demographic Variability in Two Brachial Plexus Centers

Area of Science:

• Neurosurgery
• Traumatology
• Orthopedic Surgery

Background:

• Complete brachial plexus injuries are severe and can lead to significant disability.
• A viable C5 spinal nerve is crucial for potential axonal regeneration and influences surgical strategies.
• Identifying factors predicting C5 nerve root avulsion is essential for optimizing patient outcomes.

Purpose of the Study:

• To determine the factors associated with C5 nerve root avulsion in patients with complete brachial plexus injuries.
• To compare injury characteristics and risk factors between two international centers.

Main Methods:

• A retrospective study of 200 patients with complete brachial plexus injuries was conducted across two international centers.
• Data collected included demographics, injury mechanisms, kinetic energy (KE), and Injury Severity Score.
• C5 nerve root viability was assessed through preoperative imaging, intraoperative exploration, and neuromonitoring.

Main Results:

• Complete five-nerve root avulsions were observed in 62% of US and 43% of Taiwanese patients.
• Factors increasing C5 avulsion risk included older age, longer time to surgery, higher BMI, motor vehicle accidents, increased KE, higher Injury Severity Score, and vascular injury.
• Motorcycle (≤150cc) or bicycle accidents were associated with a decreased risk of avulsion.

Conclusions:

• The incidence of complete brachial plexus avulsion injuries is high.
• Despite demographic differences between US and Taiwanese cohorts, increased accident kinetic energy consistently elevates the risk of C5 avulsion.