Summary
The diagnostic utility of imaging techniques in injuries to the intramedullary and subarachnoid portions of the brachial plexus, with possibly complete avulsion of one or more nerve roots from the spinal cord and extramedullary meningocoele was compared in 18 patients studied by unenhanced computed tomography (CT), cervical myelography, myelographic CT (MCT) and magnetic resonance imaging (MRI). Emphasis was placed on the lesions of the subarachnoid roots. CM was the only diagnostic modality to show avulsion of 18 nerve roots and their levels in 8 patients (100% = gold standard), and to verify 2 incomplete avulsions. MCT reliably revealed 8 of 18 (45%) and MRI 1 out of 18 (6%) avulsions. Myelography with MCT showed intact subarachnoid nerve roots in 10 additional patients. MRI and MCT (16 out of 16=100%) were superior to myelography (14/16=88%) for demonstrating 16 traumatic meningocoeles in 8 patients; follow-up MRI (6–24 months) showed no increase in their size. We recommend a subsequent CT to role out fracture to the spinal column; MRI should provide significant information concerning oedema or haemorrhage in the spinal cord. Myelography with segmental MCT is performed to differentiate pre- from post-ganglionic lesions. data which are essential for deciding whether exploration of the plexus or a motor substitution operation is indicated.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Alnot JY (1987) Traumatic paralysis of the brachial plexus: preoperative problems and therapeutic indications. In: Terzis JK (ed) Microreconstruction of nerve injuries. Saunders, Philadelphia; pp 325–345
Birch R (1987) Brachial plexus injuries. Curr Orthop 1:316–323
Millesi H (1987) Brachial plexus injuries: management and results. In: Terzis JK (ed) Microreconstruction of nerve injuries. Saunders, Philadelphia, pp 347–360
Taylor PE (1962) Traumatic intradural avulsion of the nerve roots of the brachial plexus. Brain 85:579–602
Murphey F, Hartung W, Kirklin JW (1947) Myelographic demonstration of avulsing injury of the brachial plexus. Am J Roentgenol 58:102–105
Yeoman PM (1968) Cervical myelography in traction injuries of the brachial plexus. J Bone Joint Surg [Br] 50:253–260
Frot B, Filipe G, Olivier H, Alnot JY, Duparc J (1973) Interêt de la myelographie cervicale à contraste positif dans l'exploration des lésions traumatiques du plexus brachial chez l'adulte. Ann Radiol 16:715–721
Wiedenmann O (1963) Neurologische Störungen als Folge von Ausrißverletzungen des Plexus brachialis im Vergleich zu den Befunden des positiven Myelogramms. Z Orthop 97:67–78
Piepgras U, Jelasic F, Kammerer V, Traupe H (1975) Radiologische Befunde bei zervikalen Wurzelausrissen. Radiologe 15: 317–322
Neuenschwander S, Brauner M, Gilbert A, Faure C (1980) La myelographie cervicale à la metrizamide dans les paralysies obstétricales du plexus brachial. Ann Radiol 23:93–98
Petras AF, Sobel DF, Mani JR, Lucas PR (1985) CT myelography in cervical root avulsion. J Comput Assist Tomogr 9:275–279
Marshall RW, De Silva RDD (1986) Computerized axial tomography in traction injuries of the brachial plexus. J Bone Joint Surg [Br] 68:734–738
Cobby MJD, Leslie IJ, Watt I (1988) Cervical myelography of nerve root avulsion injuries using water-soluble contrast media. Br J Radiol 61:673–678
Armington WG, Harnsberger HR, Osborn AG, Seay AR (1987) Radiographic evaluation of brachial plexopathy. AJNR 8:361–367
Gupta RK, Mehta VS, Banerji AK, Jain RK (1989) MR evaluation of brachial plexus injuries. Neuroradiology 31:377–381
Volle E, Hedde JP, Gormanns R (1991) Die direkte zervikale Myelographie mit Iotrolan 300. RÖFO 154:87–91
Sander B, Henkes H, Lutz N, Felix R (1989) Der Einfluß von Röntgenkontrastmitteln bei der Magnetresonanztomographie des Spinalkanals. Röntgen-Bl 42:343–345
Amundsen P, Skalpe IO (1975) Cervical myelography with a water-soluble contrast medium (metrizamide). Neuroradiology 8:209–212
Leo JS, Bergeron T, Kricheff II, Benjamin MV (1978) Metrizamide myelography for cervical spinal cord injuries. Radiology 129:707–711
Raininko R, Sonningen P (1987) Dorsal CSF space at CI-CII level. Neuroradiology 29:73–75
Dawson P, Howell M (1986) The non-ionic dimers: a new class of contrast agents. Br J Radiol 59:987–991
Harwood-Nash DCF, Petterson H (1982) CT myelography of the spine and cord. Springer, New York Berlin Heidelberg, pp 12–14
Verstraete KLA, Martens F, Smeets P, Vandekerckhove T, Meire D, Parizel PM, Van de Velde E, Calliaux L (1989) Traumatic lumbosacral nerve root meningoceles. Neuroradiology 31:425–429
Stohr M, Riffel B, Buettner US (1981) Somatosensibel evozierte Potentiale in der Diagnostik von Armplexusläsionen. EEG EMG 12:195–197
Hashimoto T, Mitomo M, Hirabuki N, Miura T, Kawai R, Nakamura H, Kawai H, Ono K, Kozuka T (1991) Nerve root avulsion of birth palsy: comparison of myelography with CT myelography and somatosensory evoked potentials. Radiology 178:841–845
Flanders AE, Schaefer DM, Doan AT, Mishkin MM, Gonzalez CF, Northrup BE (1990) Acute cervical spine trauma: correlation of MR imaging findings with degree of neurologic deficit. Radiology 177:25–33
Enzmann DR, De LaPaz R, Rubin JB (1990) Magnetic resonance of the spine, 1st edn. Mosby, St. Louis, pp 250–259
Penfield W (1949) Late spinal paralysis after avulsion of the brachial plexus. J Bone Joint Surg [Br] 31:40–41
Robertson HJ, Smith RD (1990) Cervical myelography: survey of modes of practice and major complications. Radiology 174: 79–83
Skalpe IO (1990) Cervical myelography (letter to the editor). Radiology 177:590–591
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Volle, E., Assheuer, J., Hedde, J.P. et al. Radicular avulsion resulting from spinal injury: assessment of diagnostic modalities. Neuroradiology 34, 235–240 (1992). https://doi.org/10.1007/BF00596345
Received:
Issue Date:
DOI: https://doi.org/10.1007/BF00596345