title: Brachial plexus avulsion injury repairs with nerve transfers and nerve grafts directly implanted into the spinal cord yield partial recovery of shoulder and elbow movements.
abstract: OBJECTIVE
  Complete avulsion of the brachial plexus is a devastating injury that primarily affects young adults. The current treatment is based on nerve transfers, which yield very limited recovery. In this study, brachial plexus injuries were repaired with nerve transfers and nerve grafts directly implanted into the spinal cord.
  
  
  METHODS
  Eight patients with complete brachial plexus avulsion injuries were surgically treated. Roots or target nerves of the brachial plexus were repaired with peripheral nerve grafts directly implanted into the spinal cord and with extraplexal nerve transfers.
  
  
  RESULTS
  Muscle reinnervation was observed for six patients who received spinal implants. Among those patients, one recovered M4 muscle power. Reinnervation was observed only in proximal upper limb muscles.
  
  
  CONCLUSIONS
  Muscle reinnervation through nerve grafts directly implanted into the spinal cord was demonstrated. It seems that the combination of intra- and extradural neurotizations improves the proximal muscle function results. However, the extent of this improvement is limited and, in our opinion, does not justify the use of spinal implants.
authors.affiliation: Hospital Governador Celso Ramos, Praça Getulio Vargas 322, Florianópolis, Santa Catarina 88020030, Brazil. bertelli@matrix.com.br
authors.forename: Jayme Augusto
authors.initials: JA
authors.lastname: Bertelli
authors.forename: Marcos Flavio
authors.initials: MF
authors.lastname: Ghizoni
mesh_terms: D000293:Adolescent; D000328:Adult; D001917:Brachial Plexus / Q000293:injuries* / Q000503:physiopathology / Q000601:surgery*; D004550:Elbow / Q000294:innervation / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D018482:Muscle, Skeletal / Q000294:innervation / Q000503:physiopathology; D009416:Nerve Regeneration / Q000502:physiology*; D016067:Nerve Transfer / Q000379:methods*; D020127:Recovery of Function / Q000502:physiology*; D012782:Shoulder / Q000294:innervation / Q000503:physiopathology*; D013116:Spinal Cord / Q000503:physiopathology* / Q000601:surgery*; D013497:Sural Nerve / Q000503:physiopathology* / Q000637:transplantation*