Abstract：
BACKGROUND: Systematic descriptions of anatomical damage after brachial plexus injury (BPI) at the intradural level have been scarcely reported in detail. However, considering these damages, not only in the spinal nerve roots but also in the spinal cord itself, is crucial in determining the appropriate surgical approach to restore upper limb function and address refractory pain. Therefore, the authors present a descriptive study focusing on intradural findings observed during microsurgical DREZ-lesioning.
METHODS: This study enrolled 19 consecutive patients under the same protocol. Microsurgical observation through exposure of C4 to Th1 medullary segments allowed to describe the lesions in spinal nerve roots, meninges, and spinal cord. Electrical stimulation of the ventral roots checked the muscle responses.
RESULTS: Extensive damage was observed among the 114 explored roots (six roots per patient), with only 21 (18.4%) ventral (VR) and 17 (14.9%) dorsal (DR) roots retaining all rootlets intact. Damage distribution varied, with the most frequent impairments in C6 VRs (18 patients) and the least in Th1 VRs (14 patients), while in all the 19 patients for the C6 DRs (the most frequently impaired) and in 14 patients for Th1 DRs (the less impaired). C4 roots were found damaged in 12 patients. Total or partial avulsions affected 63.3% and 69.8% of DRs and VRs, respectively, while 15.8% and 14.0% of the 114 DRs and VRs were atrophic, maintaining muscle responses to stimulation in half of those VRs. Pseudomeningoceles were present in 11 patients but absent in 46% of avulsed roots. Adhesive arachnoiditis was noted in 12 patients, and dorsal horn parenchymal alterations in 10.
CONCLUSIONS: Knowledge of intradural lesions post-BPI helps in guiding surgical indications for repair and functional neurosurgery for pain control.
METHODS: This study enrolled 19 consecutive patients under the same protocol. Microsurgical observation through exposure of C4 to Th1 medullary segments allowed to describe the lesions in spinal nerve roots, meninges, and spinal cord. Electrical stimulation of the ventral roots checked the muscle responses.
RESULTS: Extensive damage was observed among the 114 explored roots (six roots per patient), with only 21 (18.4%) ventral (VR) and 17 (14.9%) dorsal (DR) roots retaining all rootlets intact. Damage distribution varied, with the most frequent impairments in C6 VRs (18 patients) and the least in Th1 VRs (14 patients), while in all the 19 patients for the C6 DRs (the most frequently impaired) and in 14 patients for Th1 DRs (the less impaired). C4 roots were found damaged in 12 patients. Total or partial avulsions affected 63.3% and 69.8% of DRs and VRs, respectively, while 15.8% and 14.0% of the 114 DRs and VRs were atrophic, maintaining muscle responses to stimulation in half of those VRs. Pseudomeningoceles were present in 11 patients but absent in 46% of avulsed roots. Adhesive arachnoiditis was noted in 12 patients, and dorsal horn parenchymal alterations in 10.
CONCLUSIONS: Knowledge of intradural lesions post-BPI helps in guiding surgical indications for repair and functional neurosurgery for pain control.
摘要：
背景：关于臂丛神经损伤（BPI）后硬膜内解剖损伤的系统描述几乎没有详细报道。然而,考虑到这些损害，不仅在脊神经根，而且在脊髓本身，对于确定适当的手术方法以恢复上肢功能和解决难治性疼痛至关重要。因此,作者提出了一项描述性研究，重点是在显微外科手术DREZ损伤期间观察到的硬膜内发现。
方法：本研究在相同方案下连续招募19名患者。通过将C4暴露于Th1髓段进行显微外科观察，以描述脊神经根的病变，脑膜,和脊髓。电刺激腹根检查肌肉反应。
结果：在114个探索的根中观察到广泛的损伤（每个患者有6个根），只有21根（18.4％）腹侧（VR）和17根（14.9％）背根（DR）保持所有小根完整。损伤分布变化，C6VRs损伤最常见（18例），Th1VRs损伤最少（14例），而在所有19例患者中，C6DR（最常受损）和14例Th1DR（受损较少）。在12例患者中发现C4根受损。全部或部分撕脱影响了63.3%和69.8%的DR和VR，分别,而114个DR和VR中的15.8%和14.0%是萎缩的，在一半的VR中保持肌肉对刺激的反应。11例患者存在假性脑膜膨出，但46％的撕脱根中不存在。12例患者出现粘连性蛛网膜炎,和10例的背角实质改变。
结论：了解BPI术后硬膜内病变有助于指导修复手术指征和功能性神经外科控制疼痛。
方法：本研究在相同方案下连续招募19名患者。通过将C4暴露于Th1髓段进行显微外科观察，以描述脊神经根的病变，脑膜,和脊髓。电刺激腹根检查肌肉反应。
结果：在114个探索的根中观察到广泛的损伤（每个患者有6个根），只有21根（18.4％）腹侧（VR）和17根（14.9％）背根（DR）保持所有小根完整。损伤分布变化，C6VRs损伤最常见（18例），Th1VRs损伤最少（14例），而在所有19例患者中，C6DR（最常受损）和14例Th1DR（受损较少）。在12例患者中发现C4根受损。全部或部分撕脱影响了63.3%和69.8%的DR和VR，分别,而114个DR和VR中的15.8%和14.0%是萎缩的，在一半的VR中保持肌肉对刺激的反应。11例患者存在假性脑膜膨出，但46％的撕脱根中不存在。12例患者出现粘连性蛛网膜炎,和10例的背角实质改变。
结论：了解BPI术后硬膜内病变有助于指导修复手术指征和功能性神经外科控制疼痛。
