title: A novel strategy for repairing preganglionic cervical root avulsion in brachial plexus injury by sural nerve grafting.
abstract: OBJECTIVE
  In this study, the authors evaluated the efficacy of a new surgical strategy for reconnecting the injured brachial plexus with the spinal cord using fibrin glue containing acidic fibroblast growth factor as an adhesive and neurotrophic agent.
  
  
  METHODS
  Eighteen patients with preganglionic brachial plexus injuries, each with varying degrees of upper limb dysfunction, underwent cervical laminectomy with or without sural nerve grafting. The treatment of each avulsed root varied according to the severity of the injury. Some patients also underwent a second-stage operation involving supraclavicular brachial plexus exploration for reconnection with the corresponding segment of cervical spinal cord at the trunk level. Muscle strength was graded both pre- and postoperatively with the British Medical Research Council scale, and the results were analyzed with the Friedman and Wilcoxon signed-rank tests.
  
  
  RESULTS
  Muscle strength improvements were observed in 16 of the 18 patients after 24 months of follow-up. Significant improvements in mean muscle strength were observed in patients from all repair method groups at 12 and 24 months postoperatively (p < 0.05). Statistical significance was not reached in the groups with insufficient numbers of cases.
  
  
  CONCLUSIONS
  The authors' new surgical strategy yielded clinical improvement in muscle strength after preganglionic brachial plexus injury, such that nerve regeneration may have taken place. Reconnection of the brachial plexus to the cervical spinal cord is possible. Functional motor recovery, observed through increases in Medical Research Council-rated muscle strength in the affected arm, is likewise possible.
authors.affiliation: Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Jau-Ching
authors.initials: JC
authors.lastname: Wu
authors.forename: Wen-Cheng
authors.initials: WC
authors.lastname: Huang
authors.forename: Ming-Chao
authors.initials: MC
authors.lastname: Huang
authors.forename: Yun-An
authors.initials: YA
authors.lastname: Tsai
authors.forename: Yu-Chun
authors.initials: YC
authors.lastname: Chen
authors.forename: Yang-Hsin
authors.initials: YH
authors.lastname: Shih
authors.forename: Henrich
authors.initials: H
authors.lastname: Cheng
mesh_terms: D000293:Adolescent; D000328:Adult; D001339:Autonomic Fibers, Preganglionic; D001917:Brachial Plexus / Q000293:injuries*; D002648:Child; D005500:Follow-Up Studies; D006801:Humans; D007796:Laminectomy; D008875:Middle Aged; D009333:Neck; D019635:Neurosurgical Procedures / Q000379:methods*; D011843:Radiculopathy / Q000601:surgery*; D013126:Spinal Nerve Roots / Q000601:surgery*; D013497:Sural Nerve / Q000637:transplantation*; D014182:Transplantation, Autologous