ABSTRACT
The differential diagnosis between preganglionic and postganglionic lesions of the
brachial plexus at the level of individual roots is critical. Preoperative neuroradiologic
and electrophysiological studies are considered useful in detecting of root avulsions
of the brachial plexus. In this study, the predictive value of plain cervical myelography,
following computed tomography myelography (CTM) and preoperative electrodiagnostic
evaluation, in detecting nerve root avulsions in cases of obstetrical brachial plexus
paralysis was determined. The charts of 321 patients who had sustained brachial plexus
paralysis and were operated on in our center from 1982 to 2003 were reviewed and analyzed.
This study includes 70 cases of obstetrical brachial plexus palsy. Preoperative cervical
myelography and CTM, as well as electrophysiological studies, were compared with final
intraoperative diagnosis. A total of 420 spinal nerves were examined in 70 patients.
Fifty-two patients (74.3%) had avulsion injury of brachial plexus. Intraoperatively,
135 roots (32.1%) were found to be avulsed. Accuracy, sensitivity, and specificity
of preoperative plain myelography were 85.3%, 71.0%, and 92.3%; of CTM they were 89.4%,
83.2%, and 92.1%, respectively; and of electrodiagnostic studies they were 76.2%,
39.5%, and 93.2%, respectively. CTM and plain myelography were significantly more
accurate and sensitive than electrophysiological studies (p < 0.05). There was no statistically significant difference in accuracy and sensitivity
between plain myelography and CTM.
KEYWORDS
Brachial plexus - spinal nerve avulsion - myelography - electrophysiological studies
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Julia K TerzisM.D. Ph.D.
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