Rapports microchirurgicaux des racines du plexus brachial: Applications pratiques

doi:10.1016/S0753-9053(85)80122-8

Annales de Chirurgie de la Main

Volume 4, Issue 2, 1985, Pages 120-133

https://doi.org/10.1016/S0753-9053(85)80122-8 Get rights and content

Résumé

Chez 20 spécimens anatomiques frais, les racines du plexus brachial sont examinées sous microscope opératoire depuis leur origine (bifurcation du nerf rachidien correspondant) jusqu'à leur terminaison (constitution des troncs primaires). Des injections des vaisseaux de la base du cou avec du latex coloré sont réalisées dans 10 cas. La morphologie des moyens de fixité des racines plexuelles est précisée. Les branches collatérales, les anastomoses et les rapports vasculaires sont étudiés. A la lumière de ces dissections, les modalités de l'abord microchirurgical des racines jusqu'à leur origine lors d'une exploration du plexus brachial sont discutées.

Summary

The brachial plexus roots were studied in 20 cadavers under magnification from their origin (division of the corresponding cervical spinal nerves) until their ending (origin of the corresponding trunks). Regional vascular injections were performed in 10 cases using colored latex. The means of fixation of each plexus root to the spine, as well as the collateral branches, the anastomoses and the vascular connections are described. The authors conclude by the description of a microsurgical posterior approach of C5–C6 and C7 up to their origin, with clinical applications.

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Cited by (26)

Safety and Efficacy of Posterior Upper Rib Excision and Decompression Technique for Surgical Treatment of Neurogenic Thoracic Outlet Syndrome
2023, World Neurosurgery
There are several approaches used for surgical treatment of neurogenic thoracic outlet syndrome (n-TOS). The posterior upper rib excision and decompression technique is a novel technique that was developed and used by the author for the past 8 years. The purpose of this paper is to report clinical outcomes of patients treated with this approach.
All patients with n-TOS operated by single surgeon from 2015 to 2023 were retrospectively analyzed. Demographic, clinical, radiologic, surgical, and postoperative data were collected and reported with emphasis on efficacy and complications. The surgical success was evaluated subjectively as excellent, good, fair, poor, and bad. Radiologic data were analyzed to assess the extent of accessory/first rib removal.
Eighty procedures were performed in 61 patients with a mean follow-up of 1153 (87-3048) days. The majority (60.7%) of patients were women, with 39.3% being men. In 11 cases (18%) causative factor was bone abnormality. Two patients were previously operated at another centers (3.3%). Total mean subjective improvement rate was 91.5%. More than half (55) of the patients reported “excellent” (>75%) and 6 “good” improvements (50%−75%); no fair, poor, and worse outcomes were reported. Patients reporting “good” outcome had statistically significant shorter follow-ups than the “excellent” group (P < 0.001). Complications included pleural opening, Horner syndrome, and apical hematoma, none of which were permanent.
The posterior upper rib excision and decompression approach provides excellent clinical outcomes in patients with n-TOS. It allows better intraoperative visualization and removal of the first rib and full decompression of the neurovascular bundle.
Surgical reconstructions for adult brachial plexus injuries. Part I: Treatments for combined C5 and C6 injuries, with or without C7 injuries
2020, Injury
Citation Excerpt :
In fact, the total avulsion of all cervical roots is rare and only account for 16% in BPI [9]. It is especially true in the upper arm type BPI, because of the ligament structure over C5-6 foraminal region which lead the C5 and C6 proximal stump more likely to be preserved for nerve grafting [10]. The nerve grafting has several advantages, including avoidance of the possibility of donor site morbidity in nerve transfer, avoidance of the need of brain reeducation, and offering sufficient number of motor fascicles [11].
Brachial plexus injuries will cause a significantly decreased quality of life. Patients with upper arm type brachial plexus injuries, which means C5 and C6 roots injury, will lose their shoulder elevation/abduction/external rotation, and elbow flexion function. Additional elbow, wrist, and hand extension function deficit will occur in patients with C7 root injury. With the advances of reconstructive procedures, the upper arm brachial plexus injuries can be successfully restored through nerve repair, nerve grafting, nerve transfer, muscle / tendon transfer and free functioning muscle transfer. In this review article, we summarized the various reconstructive procedures to restore the function of shoulder and elbow. Nowadays, the upper arm type BPI can be treat with satisfied outcomes (80–90% successful rate).
Gross Anatomy of the Shoulder
2016, Rockwood and Matsen’s The Shoulder
Anatomy of the brachial plexus
2012, Practical Management of Pediatric and Adult Brachial Plexus Palsies
Extraforaminal ligaments of the cervical spinal nerves in humans
2011, Spine Journal
Citation Excerpt :
Herzberg et al. described a semiconic superior ligament connecting mainly C5 but, to a minor degree, also C6 and C7 to the spinal cervical spine. The ventral superior EFLs in our study resemble the ligaments described by Herzberg et al. [11]. However, the same type of ligaments are present at the levels C2–C4 and C8 and T1.
During the last 120 years, several mechanisms to protect the spinal nerve against traction have been described. All the described structures were located inside the spinal canal proximal to the intervertebral foramen. Ligaments with a comparable function just outside the intervertebral foramen are mentioned ephemerally. No studies are available about ligamentous attachments of cervical spinal nerves to adjacent vertebrae.
To identify and describe ligamentous structures at each cervical level that attaches spinal nerves to structures in the extraforaminal region.
An anatomical study of the extraforaminal attachments of the cervical spinal nerves was performed using human spinal columns.
Five embalmed human cervical spines (C1–C8) were dissected. The extraforaminal region was dissected bilaterally to describe and measure anatomical structures and their relationships with the cervical spinal nerves. Histology was done on the ligamentous connections of nerves to the adjacent vertebral structures.
The cervical spinal nerves are attached to the transverse process of the vertebrae. The connecting ligaments consist mainly of collagenous fibers.
At the cervical level, direct ligamentous connections exist between extraforaminal cervical spinal nerves and nearby structures. They may serve as a protective mechanism against traction. In addition, these ligaments play an important role in the positioning of the nerves in the intervertebral foramen.
Anatomy of the brachial plexus
2011, Practical Management of Pediatric and Adult Brachial Plexus Palsies: Expert Consult: Online, Print, and DVD

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Mémoires originauxRapports microchirurgicaux des racines du plexus brachial: Applications pratiquesMicrosurgical relations of the roots of the brachial plexus: Practical applications

Résumé

Summary

Les neurotisations par le nerf spinal (nerf accessorius) dans les avulsions radiculaires du plexus brachial

Neurologie

Bases anatomochirurgicales des neurotisations pour avulsions radiculaires du plexus brachial

Anat Clin

Anatomie et systématisation du plexus brachial de l'adulte

Anat Clin

Anatomie Topographique Descriptive et Fonctionnelle. Tome 6

Lower cervical nerve roots and their investments

Acta Chir Scand

The mechanism of cervical radicular lesions resulting from friction of forceful traction

Acta Chir Scand

Exploration chirurgicale du plexus brachial dans la paralysie obstétricale

Rev Chir Orthop

Nomenclature Anatomique Illustrée

Anatomie des nerfs crâniens et rachidiens et du système grand sympathique chez l'homme

The brachial plexus of nerves in man

The variations in its formation and branches

Am J Anat

Les rapports de la branche postérieure des nerfs cervicaux avec les articulations inter-apophysaires vertébrales

C.R. Ass Anat

Mémoires originaux
Rapports microchirurgicaux des racines du plexus brachial: Applications pratiquesMicrosurgical relations of the roots of the brachial plexus: Practical applications