Posterior subscapular approach to the brachial plexus. Report of 102 patients.

A 15-year operative experience with 105 posterior subscapular approaches to the brachial plexus in 102 patients is presented. The procedure is indicated in carefully selected cases, especially where the proximal portions of lower spinal nerves are involved. Its main advantage is proximal exposure of the plexus spinal nerves, particularly at an intraforaminal level. The indications in this series were thoracic outlet syndrome (TOS) in 51 carefully selected procedures, brachial plexus tumor involving proximal roots in 22 patients, post-irradiation brachial plexopathy in 14 cases, and proximal traumatic brachial plexus palsy in 18 patients. Thoracic outlet syndrome associated with neurological loss, recurrent TOS after a prior operation, or proximal brachial plexus surgical lesions involving the spinal nerve(s), especially at an intraforaminal level, can be approached advantageously by such a posterior subscapular approach. The technique should also be considered when prior operation, trauma, or irradiation to the neck or anterior chest wall make a posterior exploration of the plexus easier than an anterior one. Anterior exposure of the plexus is the preferable approach for the majority of lesions needing an operation, but the posterior subscapular procedure can be useful in well-selected cases.

Neurologic recovery in quadriplegia following operative treatment.

Records and radiographs of 90 patients suffering complete or motor-complete quadriplegia and treated surgically were reviewed. There were 76 men or boys and 14 women or girls; ages ranged from 15 to 75. Eighty-one were complete quadriplegics and nine had some degree of sensory preservation. After surgery 30 were unchanged, 47 obtained root recovery, and 13 recovered cord function, including two who became ambulatory. Fifty-three of the 74 (71%) patients undergoing decompressive procedures showed neurological improvement while seven of the 16 (49%) patients with fusion and no root decompression had improvement (p less than 0.05). All 26 patients with dislocations underwent closed or open reduction as part of their operative procedures; this did not appear to improve the likelihood of nerve root recovery. Since independence and quality of life may be improved by cord and root recovery, decompression of all neural structures should be considered in cervical spinal cord injury.

Dysphagia associated with cervical spine disorders: pathologic relationship?

Three cases of dysphagia in patients with large anterior cervical osteophytes are discussed. Although all three showed mechanical obstruction thought to be secondary to the bone growth, only one patient reported significant relief of the dysphagia after resection of the growths. The spinal etiologies of dysphagia and the operative results are discussed.