The value of preoperative examination and MRI for the diagnosis of graftable roots in total brachial plexus palsy.

ABSTRACT

The objective of our study was to evaluate the reliability of clinical examination paired with MRI to determine whether one or both of the superior C5 and C6 roots are graftable in cases of complete brachial plexus palsy. We conducted a retrospective study from 2013 to 2018. Twenty-seven patients who had total brachial plexus palsy and were more than 18 years of age were included. The Horner and the Tinel signs, potential phrenic nerve injury and anterior serratus muscle function were investigated. MRI with STIR 3D sequence was performed in each patient. Surgical exploration of the C5 and C6 roots confirmed if they were avulsed and, if found to be ruptured, assessed the possibility of grafting them. Serratus anterior testing had a specificity and a positive predictive value of 100% and diagnostic accuracy of 78%. The presence of the Tinel sign had a sensitivity and a negative predictive value of 100% and diagnostic accuracy of 93%. MRI had a sensitivity, specificity and diagnostic accuracy of 89%. A decision tree to determine whether or not C5 and/or C6 can be grafted has been developed. Its sensitivity and negative predictive value were 100%. This study provides initial validation of this diagnostic method for the diagnosis of graftable C5 and/or C6 roots. It could help prevent needless cervical exploration.