Nerve root avulsion of birth palsy: comparison of myelography with CT myelography and somatosensory evoked potential.

Findings at myelography and computed tomographic (CT) myelography were reviewed in 21 patients (22 limbs) with birth palsy; nerve root shadows were the focus of this study. Myelography demonstrated 51 completely avulsed roots (78%) and 14 incompletely avulsed roots (22%). A traumatic meningocele was detected at 38 roots on myelograms and 51 roots on CT myelograms. Thirteen avulsed roots (eight completely and five incompletely avulsed roots) (20%) were not associated with a meningocele. In nine patients who underwent brachial plexus exploration, myelographic findings were compared with root somatosensory evoked potential (SEP). SEP was not induced at 22 of 25 completely avulsed roots and was induced at all seven incompletely avulsed roots. Myelography and SEP were consistent in 29 of 32 roots (91%). It is concluded that myelography is indispensable for preoperative evaluation of cervical nerve root avulsion of birth palsy, because CT myelography is not sensitive to nerve root avulsion without a traumatic meningocele, and SEP cannot enable one to discriminate incomplete avulsion from intact roots.