title: Concomitant traumatic spinal cord and brachial plexus injuries in adult patients.
abstract: BACKGROUND
  Combined injuries to the spinal cord and brachial plexus present challenges in the detection of both injuries as well as to subsequent treatment. The purpose of this study is to describe the epidemiology and clinical factors of concomitant spinal cord injuries in patients with a known brachial plexus injury.
  
  
  METHODS
  A retrospective review was performed on all patients who were evaluated for a brachial plexus injury in a tertiary, multidisciplinary brachial plexus clinic from January 2000 to December 2008. Patients with clinical and/or imaging findings for a coexistent spinal cord injury were identified and underwent further analysis.
  
  
  RESULTS
  A total of 255 adult patients were evaluated for a traumatic traction injury to the brachial plexus. We identified thirty-one patients with a combined brachial plexus and spinal cord injury, for a prevalence of 12.2%. A preganglionic brachial plexus injury had been sustained in all cases. The combined injury group had a statistically greater likelihood of having a supraclavicular vascular injury (odds ratio [OR] = 22.5; 95% confidence interval [CI] = 1.9, 271.9) and a cervical spine fracture (OR = 3.44; 95% CI = 1.6, 7.5). These patients were also more likely to exhibit a Horner sign (OR = 3.2; 95% CI = 1.5, 7.2) and phrenic nerve dysfunction (OR = 2.5; 95% CI = 1.0, 5.8) compared with the group with only a brachial plexus injury.
  
  
  CONCLUSIONS
  Heightened awareness for a combined spinal cord and brachial plexus injury and the presence of various associated clinical and imaging findings may aid in the early recognition of these relatively uncommon injuries.
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Rhee
authors.forename: Elena
authors.initials: E
authors.lastname: Pirola
authors.forename: Marie-Noëlle
authors.initials: MN
authors.lastname: Hébert-Blouin
authors.forename: Michelle F
authors.initials: MF
authors.lastname: Kircher
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Spinner
authors.forename: Allen T
authors.initials: AT
authors.lastname: Bishop
authors.forename: Alexander Y
authors.initials: AY
authors.lastname: Shin
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D001917:Brachial Plexus / Q000293:injuries*; D020516:Brachial Plexus Neuropathies / Q000175:diagnosis / Q000453:epidemiology*; D002574:Cervical Vertebrae / Q000293:injuries; D016009:Chi-Square Distribution; D015331:Cohort Studies; D015897:Comorbidity; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D008159:Lumbar Vertebrae / Q000293:injuries; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000175:diagnosis / Q000453:epidemiology; D016017:Odds Ratio; D015995:Prevalence; D012189:Retrospective Studies; D017678:Sex Distribution; D013119:Spinal Cord Injuries / Q000175:diagnosis / Q000453:epidemiology*; D013904:Thoracic Vertebrae / Q000293:injuries; D014481:United States / Q000453:epidemiology; D055815:Young Adult