Repair of avulsed ventral nerve roots by direct ventral intraspinal implantation after brachial plexus injury

The avulsion of nerve roots associated with the brachial plexus results in lesions with a poor prognosis. These lesions involve the central nervous system and are therefore considered irreparable. The results of many experiments in animals have shown that if continuity can be re-established between the cervical cord and a denervated muscle or the distal end of its nerve, spinal motor neurons can regrow into a peripheral nerve graft, ultimately leading to the restoration of functional contraction. The current authors sought to prove that axons can regrow after intraspinal reimplantation of an avulsed nerve root, that such regrowth can lead to the recovery of function, and that the phenomenon should be focused on for the development of new surgical modalities to correct this serious condition. Partial reinnervation was obtained in the triceps, biceps, and deltoid muscles, and in the radial flexor muscle of the wrist, the exact pattern depending on the type of lesion and the type of graft. Treatment with neurotrophic factors represents a parallel line of research that might well help improve outcomes in spinal surgery to repair nerve root avulsion.