Nerve root transfer from C4 to C5 in brachial plexus injuries. Anatomical study and description of the surgical technique

Valeriano, Gabriel Vique; Abdouni, Yussef Ali; Costa, Antonio Carlos Da

doi:10.1055/s-0040-1722575

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Revista Brasileira de Ortopedia

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Sumário

Original Article • Rev. bras. ortop. 57 (3) • 2022 • https://doi.org/10.1055/s-0040-1722575 copy

Nerve root transfer from C4 to C5 in brachial plexus injuries. Anatomical study and description of the surgical technique^* * Study performed at the Orthopedics and Traumatology Department, Hospital da Irmandade da Santa Casa da Misericórdia de São Paulo (DOT/ISCMSP), São Paulo, SP, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

This is an anatomical study of C4 and C5 roots for nerve transfers in upper brachial plexus injuries, with surgical technique demonstration.

Methods

Fifteen brachial plexuses from both male and female cadavers were dissected. Morphological features of C4 and C5 roots were recorded and analyzed, followed by a neurotization simulation.

Results

In all dissections, C4 and C5 roots morphological features allowed their mobilization and neurotization with no need for a nerve graft. The surgical technique spared important regional nerve branches.

Conclusion

Based on these data, we conclude that C4-C5 nerve transfers are feasible and result in no additional neurological deficit in upper brachial plexus injuries.

Keywords
Brachial plexus; Cervical plexus; Nerve transfer; Spinal nerve roots

#	Age (years)	Side	Gender	Height (cm)	Weight (kg)
1	52	Right	Male	167	61
2	42	Right	Male	182	76
3	66	Left	Male	175	74
4	58	Right	Male	175	86
5	72	Left	Female	164	68
6	86	Right	Female	163	55
7	86	Left	Female	163	55
8	85	Right	Female	157	42
9	85	Left	Female	157	42
10	38	Right	Female	160	62
11	38	Left	Female	160	62
12	47	Right	Male	176	78
13	47	Left	Male	176	78
14	62	Right	Male	168	70
15	62	Left	Male	168	70
mean value	61.7			167.4	65.3
maximum value	86			182	86
minimum value	38			157	42

#	C4 length after phrenic nerve origin (mm)	C5 length after phrenic nerve origin (mm)	C5 length before phrenic nerve origin (mm)	C5 total length (mm)	C6 length (mm)	Space (Interval) between C4-C5 (mm)	Difference between C4 and C5 length (mm)
1	13	19	10	29	18	10	16
2	14	18	8	26	19	10	12
3	13	20	7	27	18	10	14
4	11	20	7	27	20	11	16
5	11	23	5	28	15	9	17
6	13	18	7	25	16	9	12
7	12	18	6	24	15	9	12
8	13	21	7	28	17	9	15
9	12	21	8	29	18	9	17
10	12	19	8	27	18	10	15
11	11	19	7	26	17	10	15
12	14	20	8	28	18	11	14
13	15	20	8	28	19	11	13
14	12	18	9	27	17	10	15
15	13	18	8	26	16	10	13
mean value	12.6	19.5	7.5	27.0	17.4	9.9	14.4
maximum value	15	23	10	33	20	11	17
minimum value	11	18	5	23	15	9	12

Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
E-mail: rbo@sbot.org.br

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[1] Address for correspondence Gabriel Vique Valeriano, Rua Martinico Prado, 284, apto 53, Vila Buarque, São Paulo, SP, Brazil (e-mail: gviquev@hotmail.com).

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Nerve root transfer from C4 to C5 in brachial plexus injuries. Anatomical study and description of the surgical technique* * Study performed at the Orthopedics and Traumatology Department, Hospital da Irmandade da Santa Casa da Misericórdia de São Paulo (DOT/ISCMSP), São Paulo, SP, Brazil.

Abstract

Objective

Methods

Results

Conclusion

Nerve root transfer from C4 to C5 in brachial plexus injuries. Anatomical study and description of the surgical technique^* * Study performed at the Orthopedics and Traumatology Department, Hospital da Irmandade da Santa Casa da Misericórdia de São Paulo (DOT/ISCMSP), São Paulo, SP, Brazil.