Evidence map›Paper›PMID 38698241›Full record

ArticleActa neurochirurgica2024

Anatomical damages in the spinal nerve roots and the spinal cord after brachial plexus injury: descriptive study from a cohort of consecutive patients who underwent DREZ-lesioning for pain-practical implications.

George Georgoulis, Eleftherios Neromyliotis, Marc Sindou

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Article in Acta neurochirurgica, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

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1 citing paper in PubMed.

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5 · Who and what money

Authors and funding

3 authors.

George GeorgoulisDepartment of Neurosurgery, General Hospital of Athens "G. Gennimatas", Mesogeion Avenue 154, 11527, Athens, Greece. gdgeorgoulis@gmail.com.ORCID 0000-0003-3368-1765
Eleftherios NeromyliotisDepartment of Neurosurgery, "Evangelismos" Hospital, University of Athens, Athens, Greece.
Marc SindouUniversity of Lyon, Lyon, France.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundSystematic descriptions of anatomical damage after brachial plexus injury (BPI) at the intradural level have been scarcely reported in detail. However, considering these damages, not only in the spinal nerve roots but also in the spinal cord itself, is crucial in determining the appropriate surgical approach to restore upper limb function and address refractory pain. Therefore, the authors present a descriptive study focusing on intradural findings observed during microsurgical DREZ-lesioning.

methodsThis study enrolled 19 consecutive patients under the same protocol. Microsurgical observation through exposure of C4 to Th1 medullary segments allowed to describe the lesions in spinal nerve roots, meninges, and spinal cord. Electrical stimulation of the ventral roots checked the muscle responses.

resultsExtensive damage was observed among the 114 explored roots (six roots per patient), with only 21 (18.4%) ventral (VR) and 17 (14.9%) dorsal (DR) roots retaining all rootlets intact. Damage distribution varied, with the most frequent impairments in C6 VRs (18 patients) and the least in Th1 VRs (14 patients), while in all the 19 patients for the C6 DRs (the most frequently impaired) and in 14 patients for Th1 DRs (the less impaired). C4 roots were found damaged in 12 patients. Total or partial avulsions affected 63.3% and 69.8% of DRs and VRs, respectively, while 15.8% and 14.0% of the 114 DRs and VRs were atrophic, maintaining muscle responses to stimulation in half of those VRs. Pseudomeningoceles were present in 11 patients but absent in 46% of avulsed roots. Adhesive arachnoiditis was noted in 12 patients, and dorsal horn parenchymal alterations in 10.

conclusionsKnowledge of intradural lesions post-BPI helps in guiding surgical indications for repair and functional neurosurgery for pain control.

Indexed as

Brachial PlexusSpinal Nerve RootsAdolescentAdultAgedBrachial Plexus NeuropathiesCohort StudiesFemaleHumansMaleMicrosurgeryMiddle AgedSpinal CordYoung AdultBrachial plexus injuryCervical spinal cordDorsal root entry zoneIntraoperative neurophysiologyMicrosurgical DREZotomySpine nerve roots

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.