The evaluation, treatment, and prognosis of neonatal brachial plexus palsy (NBPP) continues to have many areas of debate, including the use of ancillary testing. Given the continued improvement in imaging, it is important to revisit its utility. Nerve root avulsions have historically been identified by the presence of pseudomeningoceles or visible ruptures. This “all-or-none” definition of nerve root avulsions has many implications for the understanding and management of NBPP, especially as characterization of the proximal nerve root as a potential donor remains critical. This study examined the ability of high-resolution MRI to more specifically define the anatomy of nerve root avulsions by individually examining the ventral and dorsal rootlets as they exit the spinal cord.

This is a retrospective review of patients who had undergone brachial plexus protocol MRI for clinical evaluation of NBPP at a single institution. Each MR image was independently reviewed by a board-certified neuroradiologist, who was blinded to both established diagnosis/surgical findings and laterality. Each dorsal and ventral nerve rootlet bilaterally from C5 to T1 was evaluated from the spinal cord to its exit in the neuroforamen. Each rootlet was classified as avulsed, intact, or undeterminable.

Sixty infants underwent brachial plexus protocol MRI from 2010 to 2018. All infants were included in this study. Six hundred individual rootlets were analyzed. There were 49 avulsed nerve rootlets in this cohort. Twenty-nine (59%) combined dorsal/ventral avulsions involved both the ventral and dorsal rootlets, and 20 (41%) were either isolated ventral or isolated dorsal rootlet avulsions. Of the isolated avulsion injuries, 13 (65%) were dorsal only, meaning that the motor rootlets were intact.

A closer look at nerve root avulsions with MRI demonstrates a significant prevalence (approximately 41%) of isolated dorsal or ventral nerve rootlet disruptions. This finding implies that nerve roots previously labeled as “avulsed” but with only isolated dorsal (sensory) rootlet avulsion can yet provide donor fascicles in reconstruction strategies. A majority (99%) of the rootlets can be clearly visualized with MRI. These findings may significantly impact the clinical understanding of neonatal brachial plexus injury and its treatment.

新生儿臂丛神经麻痹 (NBPP) 的评估、治疗和预后在许多领域仍然存在争议，包括辅助测试的使用。鉴于成像技术的不断改进，重新审视其实用性非常重要。历史上神经根撕脱是通过假性脑膜膨出或可见破裂的存在来识别的。这种神经根撕脱的“全有或全无”定义对 NBPP 的理解和管理有很多影响，特别是近端神经根作为潜在供体的特征仍然很重要。这项研究检查了高分辨率 MRI 的能力，通过单独检查离开脊髓的腹侧和背侧细根来更具体地定义神经根撕脱的解剖结构。

这是对在单一机构接受臂丛神经核磁共振成像以进行 NBPP 临床评估的患者的回顾性研究。每张 MR 图像均由经过委员会认证的神经放射学家独立审查，该神经放射学家对已确定的诊断/手术结果和偏侧性均不知情。从 C5 到 T1 双侧的每个背侧和腹侧神经根从脊髓到它在神经孔中的出口进行评估。每个小根被分类为撕脱、完整或无法确定。

60 名婴儿在 2010 年至 2018 年期间接受了臂丛神经核磁共振检查。所有婴儿均被纳入本研究。分析了 600 个单独的细根。该队列中有 49 个撕脱神经根。29 例 (59%) 联合背/腹撕脱涉及腹侧和背根，20 例 (41%) 是孤立的腹侧或孤立的背根撕脱。在孤立的撕脱伤中，13 例 (65%) 仅在背部，这意味着运动根部完好无损。

用 MRI 仔细观察神经根撕脱情况表明，孤立的背侧或腹侧神经根断裂非常普遍（约 41%）。这一发现表明，以前标记为“撕脱”但只有孤立的背（感觉）根撕脱的神经根仍可以在重建策略中提供供体束。大多数 (99%) 的细根可以通过 MRI 清晰地看到。这些发现可能会显着影响临床对新生儿臂丛神经损伤及其治疗的理解。