TRAUMATIC INTRADURAL AVULSION OF THE NERVE ROOTS OF THE BRACHIAL PLEXUS

Abstract

OVER one hundred and thirty years have passed since traumatic avulsion from the spinal cord of the roots of the brachial plexus was first demon-strated pathologically. Although progress has been made since the adaptation of myelography to the diagnosis of this entity, the picture of intraspinal root avulsion remains rather fragmentary, formed as it is primarily of scattered reports dealing with a limited segment of the problem. In the few more comprehensive treatises, cases of avulsion are either not completely verified or are obscured by their inclusion with cases of trauma along the more peripheral course of the fibres of the plexus. In an effort to define more clearly the various aspects peculiar to root avulsion, a review of the literature and a report of three personally studied cases are presented. It is hoped that the analysis made of the data so compiled may contribute to a broader understanding of the problem and to a more effective management of these patients. Traction lesions at any level of the brachial plexus have long been known to carry a poor prognosis compared to lesions of peripheral nerves in general. That this reputation is, in part, due to the presence of unsuspected avulsion of the roots from the spinal cord has been suggested (Bonney, 1959). Since much of the data previously available on traction lesions has been based on material in which avulsion was either not present or was not verified, it is of importance to consider at this time only that material in which the presence of avulsive pathology has been verified anatomically by surgical exploration, post-mortem examination, or myelography. HISTORICAL BACKGROUND Although the first vertified case of root avulsion from the spinal cord was demonstrated at post-mortem by Flaubert (1827), it was not until