Skip to main content
Figure 5 | Journal of Brachial Plexus and Peripheral Nerve Injury

Figure 5

From: Direct cord implantation in brachial plexus avulsions: revised technique using a single stage combined anterior (first) posterior (second) approach and end-to-side side-to-side grafting neurorrhaphy

Figure 5

The combined approach for direct cord implantation. Conventional anterior dissection (anterior bifurcated black arrow) provides access to the roots, trunks and cords of the brachial plexus. Approaching the cervical cord through a conventional laminectomy (posterior bifurcated black arrow) provides adequate exposure and allows for lateral retraction of the paraspinal musculature, thus preserving their segmental nerve and vascular supply. Through the posterior incision and using a submuscular plane, a right-angled dissection forceps is inserted along the posterior aspect of C7 transvserse process, and entered into the anterior incision (bright green line). It is used to hold the proximal free ends of the graft loops and pull them gently into the posterior laminectomy incision. The red line shows the path of the nerve grafts.

Back to article page