Concomitant traumatic spinal cord and brachial plexus injuries in adult patients

Peter C. Rhee, Elena Pirola, Marie Noelle Hebert-Blouin, Michelle F. Kircher, Robert J. Spinner, Allen Thorp Bishop, Alexander Yong-Shik Shin

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background: Combined injuries to the spinal cord and brachial plexus present challenges in the detection of both injuries as well as to subsequent treatment. The purpose of this study is to describe the epidemiology and clinical factors of concomitant spinal cord injuries in patients with a known brachial plexus injury. Methods: A retrospective review was performed on all patients who were evaluated for a brachial plexus injury in a tertiary, multidisciplinary brachial plexus clinic from January 2000 to December 2008. Patients with clinical and/or imaging findings for a coexistent spinal cord injury were identified and underwent further analysis. Results: A total of 255 adult patients were evaluated for a traumatic traction injury to the brachial plexus. We identified thirty-one patients with a combined brachial plexus and spinal cord injury, for a prevalence of 12.2%. A preganglionic brachial plexus injury had been sustained in all cases. The combined injury group had a statistically greater likelihood of having a supraclavicular vascular injury (odds ratio [OR] = 22.5; 95% confidence interval [CI] = 1.9, 271.9) and a cervical spine fracture (OR = 3.44; 95% CI = 1.6, 7.5). These patients were also more likely to exhibit a Horner sign (OR = 3.2; 95% CI = 1.5, 7.2) and phrenic nerve dysfunction (OR = 2.5; 95% CI = 1.0, 5.8) compared with the group with only a brachial plexus injury. Conclusion: Heightened awareness for a combined spinal cord and brachial plexus injury and the presence of various associated clinical and imaging findings may aid in the early recognition of these relatively uncommon injuries. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

Original languageEnglish (US)
Pages (from-to)2271-2277
Number of pages7
JournalJournal of Bone and Joint Surgery - Series A
Volume93
Issue number24
DOIs
StatePublished - Dec 21 2011

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Arm Injuries
Brachial Plexus
Spinal Cord
Spinal Cord Injuries
Odds Ratio
Confidence Intervals
Wounds and Injuries
Phrenic Nerve
Vascular System Injuries
Traction
Epidemiology
Spine

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

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Concomitant traumatic spinal cord and brachial plexus injuries in adult patients. / Rhee, Peter C.; Pirola, Elena; Hebert-Blouin, Marie Noelle; Kircher, Michelle F.; Spinner, Robert J.; Bishop, Allen Thorp; Shin, Alexander Yong-Shik.

In: Journal of Bone and Joint Surgery - Series A, Vol. 93, No. 24, 21.12.2011, p. 2271-2277.

Research output: Contribution to journalArticle

Rhee, Peter C. ; Pirola, Elena ; Hebert-Blouin, Marie Noelle ; Kircher, Michelle F. ; Spinner, Robert J. ; Bishop, Allen Thorp ; Shin, Alexander Yong-Shik. / Concomitant traumatic spinal cord and brachial plexus injuries in adult patients. In: Journal of Bone and Joint Surgery - Series A. 2011 ; Vol. 93, No. 24. pp. 2271-2277.
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abstract = "Background: Combined injuries to the spinal cord and brachial plexus present challenges in the detection of both injuries as well as to subsequent treatment. The purpose of this study is to describe the epidemiology and clinical factors of concomitant spinal cord injuries in patients with a known brachial plexus injury. Methods: A retrospective review was performed on all patients who were evaluated for a brachial plexus injury in a tertiary, multidisciplinary brachial plexus clinic from January 2000 to December 2008. Patients with clinical and/or imaging findings for a coexistent spinal cord injury were identified and underwent further analysis. Results: A total of 255 adult patients were evaluated for a traumatic traction injury to the brachial plexus. We identified thirty-one patients with a combined brachial plexus and spinal cord injury, for a prevalence of 12.2{\%}. A preganglionic brachial plexus injury had been sustained in all cases. The combined injury group had a statistically greater likelihood of having a supraclavicular vascular injury (odds ratio [OR] = 22.5; 95{\%} confidence interval [CI] = 1.9, 271.9) and a cervical spine fracture (OR = 3.44; 95{\%} CI = 1.6, 7.5). These patients were also more likely to exhibit a Horner sign (OR = 3.2; 95{\%} CI = 1.5, 7.2) and phrenic nerve dysfunction (OR = 2.5; 95{\%} CI = 1.0, 5.8) compared with the group with only a brachial plexus injury. Conclusion: Heightened awareness for a combined spinal cord and brachial plexus injury and the presence of various associated clinical and imaging findings may aid in the early recognition of these relatively uncommon injuries. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.",
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