Magnetic Resonance Neurography Within a Multimodal Framework for Predicting C5 Root Graftability in Traumatic...

Area of Science:

• Neurosurgery
• Radiology
• Orthopedic Surgery

Background:

• Accurate preoperative assessment of C5 nerve root graftability is critical for effective surgical planning in brachial plexus injuries.
• This study compares the diagnostic accuracy of MRN against clinical and electrodiagnostic methods for predicting C5 graftability.

Purpose of the Study:

• To evaluate the diagnostic accuracy of MRN in predicting C5 nerve root graftability.
• To compare MRN's performance with clinical examination and electrodiagnostic studies.
• To determine optimal diagnostic models for different brachial plexus injury patterns.

Main Methods:

• Retrospective cohort study of 402 adult patients with traumatic brachial plexus injuries.
• Diagnostic modalities included physical examination, electromyography, and high-resolution MRN with avulsion severity scoring.
• Intraoperative surgical inspection served as the reference standard for graftability.

Main Results:

• MRN showed the highest predictive value for C5 graftability (OR 9.171, p < 0.001).
• Optimal prediction models varied by injury pattern: MRN + Tinel's sign for panplexus injuries (AUC 0.828), and MRN + Tinel's sign + levator scapulae MP for non-panplexus injuries (AUC 0.766).
• Electromyography demonstrated limited diagnostic value.

Conclusions:

• MRN is a valuable tool for assessing C5 nerve root graftability, outperforming other evaluated modalities.
• Combining MRN with clinical examination aids structured preoperative decision-making in brachial plexus reconstruction.