PMID- 11599837
OWN - NLM
STAT- MEDLINE
DCOM- 20011101
LR  - 20190910
IS  - 0022-3085 (Print)
IS  - 0022-3085 (Linking)
VI  - 95
IP  - 2 Suppl
DP  - 2001 Oct
TI  - Lateral interscalenic multilevel oblique corpectomies to repair ventral root 
      avulsions after brachial plexus injury in humans: anatomical study and first 
      clinical experience.
PG  - 202-7
AB  - OBJECT: Because central nervous system white matter exerts a powerful inhibitory 
      effect on axonal growth, implantation of nerve grafts or rootlets into the 
      cervical spinal cord following ventral root avulsion injury should, ideally, be 
      performed directly through the ventral root exit zone (VRExZ), which is located 
      near the anteromedial aspect of the anterior horn; the grafts/rootlets should not 
      be implanted into the white matter of the lateral cord. This is not possible when 
      using a conservative posterior approach. Therefore, the authors have studied the 
      anatomy encountered when using the anterolateral approach and evaluated the 
      technique in the particular case of avulsed ventral nerve roots. They also 
      present a case illustration of the procedure, which is used currently in their 
      department. METHODS: Anterior access to the rootlets is obtained using a lateral 
      interscalenic approach; the vertebral artery is exposed and mobilized, and 
      oblique drilling of the vertebral bodies (VBs) is performed. Because the 
      articular processes and half of the VBs are preserved, fusion is not required. 
      The approach allows the surgeon to expose the anterior aspect of the cervical 
      dura and the entire length of the emerging spinal nerves. The anterior aspect of 
      the dura is opened at the desired levels for VRExZ exposure. and the position is 
      ideal for implantation of the graft/rootlets. The interscalenic dissection is 
      mandatory so that the lesions of the supraclavicular plexus can be evaluated and 
      repaired. If necessary, the anterior approach allows for exploration of the 
      infraclavicular plexus during the same procedure. CONCLUSIONS: The use of a true 
      anterior approach to the ventral rootlets appears to be a valuable and 
      appropriate approach that avoids extensive laminectomy/facetectomy while 
      reimplantation is performed through the anterolateral sulcus itself. In this 
      approach, however, reimplantation of dorsal roots into the spinal cord remains 
      impossible.
FAU - Fournier, H D
AU  - Fournier HD
AD  - Service de Neurochirurgie, Centre Hospitalier Universitaire, Angers, France. 
      HDFournier@chu-angers.fr
FAU - Mercier, P
AU  - Mercier P
FAU - Menei, P
AU  - Menei P
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - United States
TA  - J Neurosurg
JT  - Journal of neurosurgery
JID - 0253357
SB  - IM
MH  - Adult
MH  - Aged
MH  - Brachial Plexus/*injuries
MH  - Cadaver
MH  - Cervical Vertebrae/*anatomy & histology
MH  - Humans
MH  - Male
MH  - Spinal Nerve Roots/*injuries
EDAT- 2001/10/16 10:00
MHDA- 2001/11/03 10:01
CRDT- 2001/10/16 10:00
PHST- 2001/10/16 10:00 [pubmed]
PHST- 2001/11/03 10:01 [medline]
PHST- 2001/10/16 10:00 [entrez]
AID - 10.3171/spi.2001.95.2.0202 [doi]
PST - ppublish
SO  - J Neurosurg. 2001 Oct;95(2 Suppl):202-7. doi: 10.3171/spi.2001.95.2.0202.