NERVE SURGERY IN OBSTETRIC BRACHIAL PLEXUS PALSY, REPORT OF 68 CASES

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Published Dec 7, 2017
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Vol. 95 No. 3 (2017): Issue Mar 2017

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Maher Barsaoui
Hatem Safi
Walid Said
Med Nabil Nessib

Abstract

Background: Obstetric brachial plexus palsy aredue to elongation of the brachial plexus during delivery by increasing thedistance between the head and shoulder. The majority of paralysis recoverspontaneously, but in some cases, nerve repair is necessary. The timing of thisnerve surgery and criteria for its indication are topics of discussion in theworld literature.The aim of this study is to askdirections and to evaluate the contribution of nerve surgery in improving theprognosis of this disease. Methods : This is a retrospective study thathas interested 68 cases of obstetric brachial plexus palsy who needs a nerverepair, collected over a 8 year-period (2004 - 2011). We analyzed the musclequotes and evaluate the functions of the shoulder, elbow and hand pre and postoperative. A minimum 12 months’follow-up was observed. Results : Seventy-eight patients werecollected, 33 boys and 35 girls with a 62 days mean age at first consultationand a mean birth weight of 4187 grams . The presentation was cephalic in 66 cases. Theright side was interested in 66%. Clinically, we reported 50% of total brachialplexus palsy and 50% of C5-C6 palsy.The mean age at time of surgery was 9 months 10 days. Preoperatively, the shoulder was listed 0 or 1 according to Gilbert classification in 70% of cases in the C5-C6 plasy and 90% of the total brachial palsy. After a mean follow up of 30 months, the rate was respectively 9% and 15%. In 75% of cases of total brachial palsy, the hand was listed 0 according to Raimondi scale, while in postoperative, 65% of cases, the hand was listed 2 and 3 according to Raimondi scale. Nerve rupture was the predominant lesion on the C5 and C6 root while fibrosis was predominant on C7, C8 and T1 roots. We noted 6 complications including respiratory distress. Conclusions: The nerve repair should not beperformed too early or too late. Too soon, we may operate those who can have aspontaneous recovery. Too late, the installation of the degeneration of motorendplates and muscle atrophy render unnecessary nerve repair. The absence ofbiceps clinical recovery in the 6th month of life and the presence of root-wrenching signs represented the absolute surgical indications. Its results areencouraging and improve functional outcome. 

Keywords:

Nerve ; surgery ; obstetric palsy ; brachial plexus ; neurotisation

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References

  1. Gilbert WM, Nesbitt TS, Danielsen B. Associated factors in 1611 cases of brachial plexus injury. Obstet Gynecol 1999;93:536-40.
  2. Zancolli EA. Classification and management of the shoulder in birth palsy. Orthop Clin North Am 1981;12:433-57.
  3. Metaizeau JP, Gayet C, Plenat F. Brachial plexus birth injuries, an experimental study. Chir Pediatr 1979;20:159-63.
  4. Hardy AE. Birth injuries of the brachial plexus, incidence and prognosis. J Bone Joint Surg 1981;63:98-101.
  5. Gilbert A, Razaboni R, Amar-Khodja S. Indications and results of brachial plexus surgery in obstetrical palsy. Orthop Clin North Am 1988;19:91-105.
  6. Bade SA, Lin JC, Curtis CG, et al. Extending the indications for primary nerve surgery in obstetrical brachial plexus palsy. Biomed Res Int 2014;2014:627067.
  7. El-Sayed AA. The prognostic value of concurrent horner syndrome in extended Erb obstetric brachial plexus palsy. J Child Neurol 2014;29:1356-9.
  8. Adler JB, Patterson RL. Erb's palsy, long-term results of treatment in eighty-eight cases. J Bone Joint Surg 1967;49:1052-64.
  9. Gilbert A, Valbuena S, Posso C. Obstetrical brachial plexus injuries: late functional results of the Steindler procedure. J Hand Surg Eur 2014;39;868-75.
  10. Camus M, Darbois Y. Obstetrical injuries of the newborn infant, retrospective study of 20,409 births. J Gynecol Obstet Biol Reprod 1985;14:1033-43.
  11. Gordon M. The immediate and long-term outcome of obstetric birth trauma. Am J Obstet Gynecol 1973;117:51-6.
  12. Camus M, Lefebvre G, Darbois Y. Obstetrical paralysis of the brachial plexus in breech presentation. J Gynecol Obstet Biol Reprod 1986;15:1104-6.
  13. Metaizeau JP, Prevot J, Lascombes P. Obstetrical paralysis, spontaneous development and results of early microsurgical treatment. Ann Pediatr 1984;31:93-102.
  14. Geutjens G, Gilbert A, Helsen K. Obstetric brachial plexus palsy associated with breech delivery, a different pattern of injury. J Bone Joint Surg 1996;78:303-6.
  15. Torki M, Barton L, Miller DA, et al. Severe brachial plexus palsy in women without shoulder dystocia. Obstet Gynecol 2012;120:539-41.
  16. Boome RS, Kaye JC. Obstetric traction injuries of the brachial plexus, natural history, indications for surgical repair and results. J Bone Joint Surg 1988;70:571-6.
  17. Slooff AC. Obstetric brachial plexus lesions and their neurosurgical repair. Microsurgery 1995;16:30-4.
  18. Metaizeau JP, Gayet C, Plenat F. Les lésions obstétricales du plexus brachial. Chir Pédiatr 1979;20:159.
  19. Laurent JP, Lee R, Shenaq S, et al. Neurosurgical correction of upper brachial plexus birth injuries. J Neurosurg 1993;79:197-203.
  20. Gilbert A. Long-term evaluation of brachial plexus surgery in obstetrical palsy. Hand Clin 1995;11:583-95.
  21. Clarke HM, Al Quattan MM, Curtis CG, et al. Obstetrical brachial plexus palsy, results following neurolysis of conducting neuromas in continuity. Plast Reconst Surg 1996;97:974- 82.
  22. La Scala G, Sean BC, Howard M. Complications of microsurgical reconstruction of obstetrical brachial plexus palsy. Plast Reconst Surg 2003;111:1383-8.