{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T15:12:13Z","timestamp":1772464333597,"version":"3.50.1"},"reference-count":13,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2015,6]]},"abstract":"<jats:sec>\n<jats:title>OBJECT<\/jats:title>\n<jats:p>In this report, the authors review complications related to the modified prespinal route in contralateral C-7 transfer for repairing brachial plexus nerve root avulsion injury and suggest a prevention strategy.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>A retrospective, nonselected amalgamation of every case of modified contralateral C-7 transfer through the prespinal route was undertaken. The study population comprised 425 patients treated between February 2002 and August 2009. The patients were managed according to a standardized protocol by one senior professor. The surgical complications were grouped into one of the following categories: those associated with tunnel making through the prespinal route, those related to the dissection and transection of the contralateral C-7 nerve root, and those that occurred in the postoperative period.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>The study population included 379 male and 46 female patients whose average age was 21 years (range 3 months to 56 years). A total of 401 patients were diagnosed with traumatic brachial plexus injury, the leading cause of which was motor vehicle accident, and 24 patients were diagnosed with obstetrical brachial plexus palsy. The contralateral C-7 nerve root was cut at the proximal side of the division portion of the middle trunk in 15 cases and sectioned at the distal end of the anterior and posterior divisions in 410 cases. The overall incidence of complications was 5.4% (23 of 425). Complications associated with making a prespinal tunnel occurred in 12 cases, including severe bleeding due to vertebral artery injury during the procedure in 2 cases (0.47%), temporary recurrent laryngeal nerve palsy in 5 cases (1.18%), pain and numbness in the donor upper extremity during swallowing in 4 cases (0.94%), and dyspnea caused by thrombosis of the brainstem 42 hours postoperatively in 1 case (0.24%); this last patient died 38 days after the operation. Complications related to exploration and transection of the contralateral C-7 nerve root occurred in 11 cases, including deficiency in extensor strength of the fingers and thumb in 4 cases (0.94%) due to injury to the posterior division of the lower trunk, unbearable pain on the donor upper extremity in 3 cases (0.71%), Horner's syndrome in 2 children (0.47%) who suffered birth palsy, a section of C-6 nerve root mistaken as C-7 in l case (0.24%), and atrophy of the sternocostal part of the pectoralis major in 1 case (0.24%).<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>The most serious complications of using the modified prespinal route in contralateral C-7 transfer were vertebral artery laceration and injury to the posterior division of the lower trunk. The prevention of such complications is necessary to popularize this surgical procedure and attain good long-term clinical results.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2014.10.jns131574","type":"journal-article","created":{"date-parts":[[2014,12,12]],"date-time":"2014-12-12T15:02:24Z","timestamp":1418396544000},"page":"1421-1428","source":"Crossref","is-referenced-by-count":26,"title":["Complications of contralateral C-7 transfer through the modified prespinal route for repairing brachial plexus root avulsion injury: a retrospective study of 425 patients"],"prefix":"10.3171","volume":"122","author":[{"given":"Wenjun","family":"Li","sequence":"first","affiliation":[{"name":"Department of Hand Surgery, Beijing Jishuitan Hospital, Peking University, Beijing;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shufeng","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Hand Surgery, Beijing Jishuitan Hospital, Peking University, Beijing;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jianyong","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Hand Surgery, Cangzhou Hospital of Integrated TCM and WM Hospital, Hebei Medical University, Cangzhou, China; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M. Fazlur","family":"Rahman","sequence":"additional","affiliation":[{"name":"Department of Hand Surgery, Aga Khan University Hospital, Karachi, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yucheng","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Hand Surgery, Beijing Jishuitan Hospital, Peking University, Beijing;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pengcheng","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Hand Surgery, Beijing Jishuitan Hospital, Peking University, Beijing;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yunhao","family":"Xue","sequence":"additional","affiliation":[{"name":"Department of Hand Surgery, Beijing Jishuitan Hospital, Peking University, Beijing;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1-jns131574","series-title":"J Vasc Surg","doi-asserted-by":"publisher","first-page":"741","DOI":"10.1016\/j.jvs.2012.09.006","article-title":"Contemporary outcomes of vertebral artery injury","volume":"57","author":"Alterman","year":"2013"},{"key":"b2-jns131574","series-title":"J Hand Surg Am","doi-asserted-by":"publisher","first-page":"270","DOI":"10.1016\/j.jhsa.2011.10.014","article-title":"Minimum 4-year follow-up on contralateral C7 nerve transfers for brachial plexus injuries","volume":"37","author":"Chuang","year":"2012"},{"issue":"6 Suppl Operative","key":"b3-jns131574","series-title":"Neurosurgery","first-page":"252","article-title":"Contralateral C7 transfer to lower trunk via a subcutaneous tunnel across the anterior surface of chest and neck for total root avulsion of the brachial plexus: a preliminary report","volume":"66","author":"Feng","year":"2010"},{"key":"b4-jns131574","series-title":"Chin Med J (Engl)","first-page":"866","article-title":"Long term outcome of contralateral C7 transfer: a report of 32 cases","volume":"115","author":"Gu","year":"2002"},{"key":"b5-jns131574","series-title":"Microsurgery","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1002\/micr.10113","article-title":"Clinical application of ipsilateral C7 nerve root transfer for treatment of C5 and C6 avulsion of brachial plexus","volume":"23","author":"Gu","year":"2003"},{"key":"b6-jns131574","series-title":"J Reconstr Microsurg","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1055\/s-2007-1006902","article-title":"Long-term functional results of contralateral C7 transfer","volume":"14","author":"Gu","year":"1998"},{"key":"b7-jns131574","series-title":"J Hand Surg Br","doi-asserted-by":"publisher","first-page":"518","DOI":"10.1016\/S0266-7681(05)80235-9","article-title":"Seventh cervical nerve root transfer from the contralateral healthy side for treatment of brachial plexus root avulsion","volume":"17","author":"Gu","year":"1992"},{"key":"b8-jns131574","series-title":"Auton Neurosci","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1016\/j.autneu.2009.11.004","article-title":"Sympathetic preganglionic neurons project to superior cervical ganglion via C7 spinal nerve in pup but not in adult rats","volume":"154","author":"Huang","year":"2010"},{"key":"b9-jns131574","series-title":"Microsurgery","doi-asserted-by":"publisher","first-page":"535","DOI":"10.1002\/micr.20911","article-title":"Electrophysiological study of the dominant motor innervation to the extensor digitorum communis muscle and long head of triceps brachii at posterior divisions of brachial plexus","volume":"31","author":"Li","year":"2011"},{"key":"b10-jns131574","series-title":"J Hand Surg Br","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1054\/JHSB.2001.0665","article-title":"The prespinal route in contralateral C7 nerve root transfer for brachial plexus avulsion injuries","volume":"27","author":"McGuiness","year":"2002"},{"key":"b11-jns131574","series-title":"Microsurgery","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1002\/micr.20963","article-title":"Contralateral C7 nerve root transfer to neurotize the upper trunk via a modified prespinal route in repair of brachial plexus avulsion injury","volume":"32","author":"Wang","year":"2012"},{"key":"b12-jns131574","series-title":"J Bone Joint Surg Am","doi-asserted-by":"publisher","first-page":"821","DOI":"10.2106\/JBJS.L.00039","article-title":"Contralateral C7 nerve transfer with direct coaptation to restore lower trunk function after traumatic brachial plexus avulsion","volume":"95","author":"Wang","year":"2013"},{"key":"b13-jns131574","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"553","DOI":"10.1227\/01.NEU.0000324729.03588.BA","article-title":"Contralateral C7 transfer via the prespinal and retropharyngeal route to repair brachial plexus root avulsion: a preliminary report","volume":"63","author":"Xu","year":"2008"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/122\/6\/article-p1421.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/122\/6\/article-p1421.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/122\/6\/article-p1421.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,7,24]],"date-time":"2022-07-24T22:28:03Z","timestamp":1658701683000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/122\/6\/article-p1421.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,6]]},"references-count":13,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.3171\/2014.10.jns131574","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,6]]}}}