title: Transdiscal C6-C7 contralateral C7 nerve root transfer in the surgical repair of brachial plexus avulsion injuries.
abstract: BACKGROUND
  Repair of complete brachial plexus avulsion injuries may require contralateral C7 nerve root transfer. The available techniques might allow direct neuroraphy in about 50 % of cases but the others require interposing nerve grafts or humeral shaft shortening. We aimed to see if transdiscal C6-C7 contralateral C7 nerve root transfer is technically feasible and if it allows direct coaptation with the contralateral nerve roots in 100 % of cases.
  
  
  METHODS
  In ten fresh-frozen adult cadavers, the C7 nerve root was sectioned just before it connects with other brachial plexus branches and re-routed though the C6-C7 disc space to the contralateral side. A complete C6-C7 discectomy was performed and the disc space kept open with the aid of an autologous iliac crest bone graft.
  
  
  RESULTS
  Transdiscal C6-C7 contralateral C7 nerve root transfer is technically feasible. In our cadavers, it provided 5.3 ± 1.2 SDcm of extra length that allowed direct coaptation with the contralateral nerve roots, mainly C8 and T1.
  
  
  CONCLUSIONS
  Transdiscal C6-C7 contralateral C7 nerve root transfer is technically feasible. In our dissections it lengthens the available C7 nerve root stump by 5.3 ± 1.2SDcm. The increase was 4 cm versus the retropharyngeal route making direct coaptation with the contralateral C8 and T1 nerve roots possible.
authors.affiliation: Servicio de Neurocirugía, Hospital General Universitario de Valencia, Avda. Tres Cruces 3, 46015, Valencia, Spain. vvanaclo@hotmail.com.
authors.forename: Vicente
authors.initials: V
authors.lastname: Vanaclocha
authors.affiliation: Servicio de Neurocirugía, Hospital General Universitario de Valencia, Avda. Tres Cruces 3, 46015, Valencia, Spain.
authors.forename: Juan Manuel
authors.initials: JM
authors.lastname: Herrera
authors.affiliation: Servicio de Neurocirugía, Hospital General Universitario de Valencia, Avda. Tres Cruces 3, 46015, Valencia, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Verdu-Lopez
authors.affiliation: Servicio de Neurocirugía, Hospital General Universitario de Valencia, Avda. Tres Cruces 3, 46015, Valencia, Spain.
authors.forename: Laurabel
authors.initials: L
authors.lastname: Gozalbes
authors.affiliation: Servicio de Neurocirugía, Hospital General Universitario de Valencia, Avda. Tres Cruces 3, 46015, Valencia, Spain.
authors.forename: Moises
authors.initials: M
authors.lastname: Sanchez-Pardo
authors.affiliation: Servicio de Neurocirugía, Hospital General Universitario de Valencia, Avda. Tres Cruces 3, 46015, Valencia, Spain.
authors.forename: Marlon
authors.initials: M
authors.lastname: Rivera
authors.affiliation: Servicio de Neurocirugía, Hospital General Universitario de Valencia, Avda. Tres Cruces 3, 46015, Valencia, Spain.
authors.forename: Deborah
authors.initials: D
authors.lastname: Martinez-Gomez
authors.affiliation: Servicio de Neurocirugía, Hospital General Universitario de Valencia, Avda. Tres Cruces 3, 46015, Valencia, Spain.
authors.forename: Juan D
authors.initials: JD
authors.lastname: Mayorga
mesh_terms: D000328:Adult; D000368:Aged; D001917:Brachial Plexus / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016067:Nerve Transfer / Q000379:methods*; D011843:Radiculopathy / Q000601:surgery*
keywords: Brachial plexus injury; Brachial plexus repair; Contralateral C7 nerve root transfer; Nerve root avulsion; Peripheral nerve