OUTCOME FOLLOWING EARLY NEUROSURGICAL MANAGEMENT OF BRACHIAL PLEXUS BIRTH INJURIES: AN ANALYSIS OF 100 CONSECUTIVE CASES

Objectives: To provide outcome data on surgically treated brachial plexus birth injuries that can be compared to published data on outcome following nonoperative treatment.

Methods: Over a 34-month period from 2000 to 2002, 100 consecutive infants underwent surgical reconstruction of a brachial plexus birth injury. The retrospective study group included 49 girls and 51 boys. The right side was involved in 57cases; the left side in 43 cases. Three cases showed evidence of bilateral injury. The pattern of injury was as follows: C5/C6 (n=53), C5/C6±C7 (n=33), global palsy (n=14). Surgery was indicated based on motor recovery at 3–4 months for global injuries but at 6–8 months for C5/C6±C7 lesions. All patients underwent exploration with microsurgical neurolysis and nerve reconstruction using a combination of nerve grafts and transfers. Ten patients had a combined shoulder reconstruction. All patients were followed for a minimum of 2.5 years prior to data analysis. Shoulder and hand function were evaluated using the international Gilbert-Raimondi scales.

Results: In C5/C6±C7 palsies, all patients advanced at least 2 shoulder grades with 50% in the good to excellent range. Children with global palsies had similar significant advances in shoulder function, return of elbow flexion in 100% of cases, and satisfactory or better hand function in 70% of cases. No perioperative complications occurred. No patient underwent a secondary procedure during the study period.

Conclusion: In appropriately selected cases, surgery can significantly improve the functional outcome in children with brachial plexus birth injuries.