Coaptation of the anterior rami of C-3 and C-4 to the upper trunk of the brachial plexus for cervical nerve root avulsion.

No surgical procedure has been available to repair cervical nerve root avulsion inside the spinal canal. Results with peripheral neurotization of denervated muscles have been discouraging. The authors have performed bridge-graft coaptation in three patients with C-5 and C-6 nerve root avulsion. The components of the coaptation included the anterior primary rami of C-3 and C-4 as the donor material, the entire upper trunk as the recipient, and the sural nerve graft as the bridge. This procedure resulted in restoration of motor function in the biceps and shoulder-girdle muscles and produced improved sensation. Stimulation of the C-3 and C-4 nerve roots elicited electrical responses in the biceps and deltoid muscles that indicated nerve growth through the graft and the brachial plexus into these muscles. This reconstructive procedure is effective and should stimulate development of new approaches to treatment of cervical nerve root avulsion and proximal brachial plexopathy.