{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T04:59:08Z","timestamp":1792299548236,"version":"4.4.0"},"reference-count":19,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>The incorporation of ancillary testing in the preoperative setting for patients with neonatal brachial plexus palsy (NBPP) remains controversial, but the recommendation for early nerve reconstruction when a baby has a preganglionic lesion at the lower nerve roots is generally accepted. At some specialty centers, nerve surgeons use preoperative electrodiagnostic testing (EDX) and imaging to aid in lesion localization and the preoperative planning of the nerve reconstruction. EDX and imaging have been evaluated for their abilities to detect pre- and postganglionic lesions, but their accuracies have never been compared directly in the same set of patients. The aim of the present study was to evaluate the accuracy of imaging and EDX in an NBPP population.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>A retrospective review was conducted of 54 patients with operative NBPP seen between 2007 and 2017. The patients underwent EDX and imaging: EDX was performed, and the results were reviewed by board-certified electrodiagnosticians, and imaging was reviewed by board-certified neuroradiologists. The gold standard was considered to be the findings at surgical exploration. Descriptive and analytical statistics were utilized to compare the accuracies of imaging and EDX.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>The mean age at surgery was 6.94 mos (\u00b1 4 mos). Fifteen patients (28%) were Narakas grade I\u2013II, and 39 (72%) were Narakas grade III\u2013IV. For all nerve roots, the overall accuracy of detecting preganglionic lesions was 74% for EDX and 69% for imaging. The overall sensitivity of detecting preganglionic lesions by EDX was 31%, but the specificity was 90%. The overall sensitivity of detecting preganglionic lesions by imaging was 66%, and the overall specificity was 70%. However, at C8, EDX was 37.5% sensitive and 87.5% specific, whereas imaging was 67.7% sensitive but only 29.4% specific.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>EDX outperformed imaging with regard to specificity and accuracy of identifying preganglionic injuries. This finding is especially relevant in the lower nerve roots, given that lower plexus preganglionic lesions are an accepted indication for early intervention.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2018.7.peds18193","type":"journal-article","created":{"date-parts":[[2018,11,15]],"date-time":"2018-11-15T23:51:00Z","timestamp":1542325860000},"page":"119-124","source":"Crossref","is-referenced-by-count":17,"title":["Comparative accuracies of electrodiagnostic and imaging studies in neonatal brachial plexus palsy"],"prefix":"10.3171","volume":"23","author":[{"given":"Brandon W.","family":"Smith","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kate W. C.","family":"Chang","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynda J. S.","family":"Yang","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary Catherine","family":"Spires","sequence":"additional","affiliation":[{"name":"Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Acta Paediatr","doi-asserted-by":"publisher","first-page":"1214","DOI":"10.1111\/j.1651-2227.1997.tb14849.x","article-title":"Perinatally acquired brachial plexus palsy\u2014a persisting challenge","volume":"86","author":"Bager B","year":"1997","unstructured":"Bager B: Perinatally acquired brachial plexus palsy\u2014a persisting challenge. Acta Paediatr 86:1214\u20131219, 199710.1111\/j.1651-2227.1997.tb14849.x9401516"},{"key":"b2","series-title":"J Hand Surg Br","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1016\/j.jhsb.2003.10.018","article-title":"The towel test: a useful technique for the clinical and electromyographic evaluation of obstetric brachial plexus palsy","volume":"29","author":"Bertelli JA","year":"2004","unstructured":"Bertelli JA, Ghizoni MF: The towel test: a useful technique for the clinical and electromyographic evaluation of obstetric brachial plexus palsy. J Hand Surg Br 29:155\u2013158, 200410.1016\/j.jhsb.2003.10.018"},{"key":"b3","series-title":"J Hand Surg Br","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1016\/S0266-7681(02)00281-4","article-title":"Neurophysiological prediction of outcome in obstetric lesions of the brachial plexus","volume":"28","author":"Bisinella GL","year":"2003","unstructured":"Bisinella GL, Birch R, Smith SJM: Neurophysiological prediction of outcome in obstetric lesions of the brachial plexus. J Hand Surg Br 28:148\u2013152, 200310.1016\/S0266-7681(02)00281-412631487"},{"issue":"1 Suppl","key":"b4","series-title":"Plast Reconstr Surg","first-page":"144e","article-title":"Obstetrical brachial plexus palsy","volume":"124","author":"Borschel GH","year":"2009","unstructured":"Borschel GH, Clarke HM: Obstetrical brachial plexus palsy. Plast Reconstr Surg 124 (1 Suppl):144e\u2013155e, 2009"},{"key":"b5","series-title":"Plast Reconstr Surg","doi-asserted-by":"publisher","first-page":"971","DOI":"10.1097\/00006534-200010000-00001","article-title":"Predictive value of computed tomographic myelography in obstetrical brachial plexus palsy","volume":"106","author":"Chow BC","year":"2000","unstructured":"Chow BC, Blaser S, Clarke HM: Predictive value of computed tomographic myelography in obstetrical brachial plexus palsy. Plast Reconstr Surg 106:971\u2013979, 200010.1097\/00006534-200010000-0000111039366"},{"key":"b6","series-title":"J Bone Joint Surg Am","doi-asserted-by":"publisher","first-page":"1258","DOI":"10.2106\/JBJS.G.00853","article-title":"The epidemiology of neonatal brachial plexus palsy in the United States","volume":"90","author":"Foad SL","year":"2008","unstructured":"Foad SL, Mehlman CT, Ying J: The epidemiology of neonatal brachial plexus palsy in the United States. J Bone Joint Surg Am 90:1258\u20131264, 200810.2106\/JBJS.G.0085318519319"},{"key":"b7","series-title":"J Pediatr Orthop","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1097\/01241398-200403000-00012","article-title":"Management of complete obstetric brachial plexus lesions","volume":"24","author":"Haerle M","year":"2004","unstructured":"Haerle M, Gilbert A: Management of complete obstetric brachial plexus lesions. J Pediatr Orthop 24:194\u2013200, 20041507660710.1097\/01241398-200403000-00012"},{"key":"b8","series-title":"J Pediatr Rehabil Med","first-page":"141","article-title":"Nerve surgery for neonatal brachial plexus palsy","volume":"4","author":"Malessy MJA","year":"2011","unstructured":"Malessy MJA, Pondaag W: Nerve surgery for neonatal brachial plexus palsy. J Pediatr Rehabil Med 4:141\u2013148, 201121955972"},{"issue":"4 Suppl","key":"b9","series-title":"Neurosurgery","first-page":"A153","article-title":"Electromyography, nerve action potential, and compound motor action potentials in obstetric brachial plexus lesions: validation in the absence of a \u201cgold standard\u201d","volume":"65","author":"Malessy MJA","year":"2009","unstructured":"Malessy MJA, Pondaag W, van Dijk JG: Electromyography, nerve action potential, and compound motor action potentials in obstetric brachial plexus lesions: validation in the absence of a \u201cgold standard\u201d. Neurosurgery 65 (4 Suppl):A153\u2013A159, 2009"},{"issue":"1 Suppl","key":"b10","series-title":"J Neurosurg","first-page":"33","article-title":"Recovery of hand function following nerve grafting and transfer in obstetric brachial plexus lesions","volume":"105","author":"Pondaag W","year":"2006","unstructured":"Pondaag W, Malessy MJA: Recovery of hand function following nerve grafting and transfer in obstetric brachial plexus lesions. J Neurosurg 105 (1 Suppl):33\u201340, 200616871868"},{"key":"b11","series-title":"Dev Med Child Neurol","doi-asserted-by":"publisher","first-page":"138","DOI":"10.1111\/j.1469-8749.2004.tb00463.x","article-title":"Natural history of obstetric brachial plexus palsy: a systematic review","volume":"46","author":"Pondaag W","year":"2004","unstructured":"Pondaag W, Malessy MJ, van Dijk JG, Thomeer RT: Natural history of obstetric brachial plexus palsy: a systematic review. Dev Med Child Neurol 46:138\u2013144, 200410.1111\/j.1469-8749.2004.tb00463.x14974639"},{"key":"b12","series-title":"AJNR Am J Neuroradiol","doi-asserted-by":"publisher","first-page":"1209","DOI":"10.3174\/ajnr.A3820","article-title":"High-resolution MRI evaluation of neonatal brachial plexus palsy: A promising alternative to traditional CT myelography","volume":"35","author":"Somashekar D","year":"2014","unstructured":"Somashekar D, Yang LJS, Ibrahim M, Parmar HA: High-resolution MRI evaluation of neonatal brachial plexus palsy: A promising alternative to traditional CT myelography. AJNR Am J Neuroradiol 35:1209\u20131213, 201410.3174\/ajnr.A382024356673"},{"key":"b13","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"1393","DOI":"10.1007\/s00381-016-3106-2","article-title":"The current role of diagnostic imaging in the preoperative workup for refractory neonatal brachial plexus palsy","volume":"32","author":"Somashekar DK","year":"2016","unstructured":"Somashekar DK, Wilson TJ, DiPietro MA, Joseph JR, Ibrahim M, Yang LJS, : The current role of diagnostic imaging in the preoperative workup for refractory neonatal brachial plexus palsy. Childs Nerv Syst 32:1393\u20131397, 201610.1007\/s00381-016-3106-227179536"},{"key":"b14","series-title":"Radiology","doi-asserted-by":"publisher","first-page":"508","DOI":"10.1148\/radiol.10101417","article-title":"Obstetric brachial plexus lesions: CT myelography","volume":"259","author":"Steens SCA","year":"2011","unstructured":"Steens SCA, Pondaag W, Malessy MJA, Verbist BM: Obstetric brachial plexus lesions: CT myelography. Radiology 259:508\u2013515, 20112133056710.1148\/radiol.10101417"},{"key":"b15","series-title":"Semin Plast Surg","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1055\/s-2005-867112","article-title":"Radiological and electrophysiological detection of nerve roots avulsion in patients with birth-related brachial plexus paralysis","volume":"19","author":"Terzis JK","year":"2005","unstructured":"Terzis JK, Novikov ML: Radiological and electrophysiological detection of nerve roots avulsion in patients with birth-related brachial plexus paralysis. Semin Plast Surg 19:24\u201341, 200510.1055\/s-2005-867112"},{"key":"b16","series-title":"J Neurosurg Pediatr","doi-asserted-by":"publisher","first-page":"283","DOI":"10.3171\/2011.12.PEDS11416","article-title":"Utility of electrodiagnostic testing and computed tomography myelography in the preoperative evaluation of neonatal brachial plexus palsy","volume":"9","author":"Vanderhave KL","year":"2012","unstructured":"Vanderhave KL, Bovid K, Alpert H, Chang KWC, Quint DJ, Leonard JA Jr, : Utility of electrodiagnostic testing and computed tomography myelography in the preoperative evaluation of neonatal brachial plexus palsy. J Neurosurg Pediatr 9:283\u2013289, 20122238095710.3171\/2011.12.PEDS11416"},{"key":"b17","series-title":"Muscle Nerve","doi-asserted-by":"publisher","first-page":"260","DOI":"10.1002\/(SICI)1097-4598(199802)21:2<260::AID-MUS20>3.0.CO;2-4","article-title":"Why is the electromyogram in obstetric brachial plexus lesions overly optimistic?","volume":"21","author":"van Dijk JG","year":"1998","unstructured":"van Dijk JG, Malessy MJ, Stegeman DF: Why is the electromyogram in obstetric brachial plexus lesions overly optimistic? Muscle Nerve 21:260\u2013261, 199810.1002\/(SICI)1097-4598(199802)21:2<260::AID-MUS20>3.0.CO;2-4"},{"key":"b18","series-title":"J Hand Surg Eur","doi-asserted-by":"publisher","first-page":"250","DOI":"10.1177\/1753193417729587","article-title":"The diagnostic accuracy of 1.5T magnetic resonance imaging for detecting root avulsions in traumatic adult brachial plexus injuries","volume":"43","author":"Wade RG","year":"2018","unstructured":"Wade RG, Itte V, Rankine JJ, Ridgway JP, Bourke G: The diagnostic accuracy of 1.5T magnetic resonance imaging for detecting root avulsions in traumatic adult brachial plexus injuries. J Hand Surg Eur Vol 43:250\u2013258, 201810.1177\/1753193417729587"},{"key":"b19","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"335","DOI":"10.1093\/neuros\/nyx190","article-title":"Prediction algorithm for surgical intervention in neonatal brachial plexus palsy","volume":"82","author":"Wilson TJ","year":"2018","unstructured":"Wilson TJ, Chang KWC, Yang LJS: Prediction algorithm for surgical intervention in neonatal brachial plexus palsy. Neurosurgery 82:335\u2013342, 201810.1093\/neuros\/nyx19028419287"}],"container-title":["Journal of Neurosurgery: Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/23\/1\/article-p119.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/23\/1\/article-p119.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/23\/1\/article-p119.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,15]],"date-time":"2023-04-15T13:27:21Z","timestamp":1681565241000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/23\/1\/article-p119.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,1]]},"references-count":19,"journal-issue":{"issue":"1"},"URL":"https:\/\/doi.org\/10.3171\/2018.7.peds18193","relation":{},"ISSN":["1933-0707","1933-0715"],"issn-type":[{"value":"1933-0707","type":"print"},{"value":"1933-0715","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,1]]}}}