The impact of different degrees of injured C7 nerve transfer: An experimental rat study

Background: Ipsilateral C7 nerve transfer is an available procedure in C5C6 2-root avulsion injury of the brachial plexus. However, concomitant injury of a normal-looking C7 cannot be ruled out. The efficiency of a concomitant injury of C7 transfer was investigated. Methods: Forty-two Sprague-Dawley rats were randomly assigned to 5 groups. They all underwent a 2-stage procedure. In the first stage from dorsal spine approach, left C5 and C6 roots were avulsed and C7 was crushed with jeweler’s forceps with different degrees: group A (n = 6), C7 not injured; group B (n = 10), C7 crushed for 10 seconds; group C (n = 10), C7 crushed for 30 seconds; group D (n = 10), C7 doubly crushed for 60 seconds; and group E (n = 6), C7 transected and not repaired. Four weeks later in the second stage, the C7 was reexplored via volar approach, transected, and coapted to the musculocutaneous nerve. At 12 weeks following the nerve transfer, functional outcomes were assessed. Results: Grooming test, muscle weight, electromyography, and muscle tetanic contraction force all showed that the biceps muscles were significantly worse in group C (moderate crush) and group D (severe crush). Group B (mild crush) and group A (uninjured) showed no difference. Group E (C7 cut and not repaired) was the worst. Conclusions: An injured but grossly normal-looking ipsilateral C7 can be used as a motor source but with variable results. The result is directly proportional to the severity of injury, potentially implying that better results will be achieved when longer regeneration time is allowed.