Advanced radiological work-up as an adjunct to decision in early reconstructive surgery in brachial plexus injuries

Seven consecutive male patients (median age 33; range 15-61) with brachial plexus injuries, caused by motor cycle accidents in 5/7 patients, who underwent extensive radiological work-up with magnetic resonance imaging (MRI), computed tomography myelography (CT-M) or both were included in this retrospective study. A total of 34 spinal nerve roots were evaluated by neuroradiologists at two different occasions. The degree of agreement between the radiological findings of every individual nerve root and the intraoperative findings was estimated by calculation of kappa coefficient (К-value). Using the operative findings as a gold standard, the accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the clinical findings and the radiological findings were estimated.The diagnostic accuracy of radiological findings was 88% compared with 65% for the clinical findings. The concordance between the radiological findings and the intraoperative findings was substantial (К = 0.76) compared with only fair (К = 0.34) for the clinical findings. There were two false positive and two false negative radiological findings (sensitivity and PPV of 0.90; specificity and NPV of 0.87).The advanced optimized radiological work-up used showed high reliability and substantial agreement with the intraoperative findings in adult patients with brachial plexus injury.The most common cause of closed brachial plexus injuries in adults is a motorcycle accident (70%) [1,2]. The generally agreed mechanism of a brachial plexus injury is traction stress on the plexus as the head and the shoulder are forced apart [3]. Up to 2/3 of high energy brachial plexus injuries may need surgical intervention [2]. Thus, the preoperative planning to determine type, level and extent of the injury is crucial for optimal selection of patients that benefit from surgical reconstruction and to plan the surgical procedure. Early reconstructive surgery of nerve injuries encourag