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Figure 9 | Journal of Brachial Plexus and Peripheral Nerve Injury

Figure 9

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 9

The extreme lateral approach. To approach the cord posteriorly, the transverse processes of C4-7 are approached through a connective tissue plane between the levator scapula and the posterior and medial scalenus muscles. The longissimus muscle has to be split longitudinally to approach the posterior tubercles of the transverse processes (black arrow). As mentioned before, the paraspinal muscles are too bulky to be retracted medially adequately. Besides, medial retraction damages their nerve and vascular supply.

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Journal of Brachial Plexus and Peripheral Nerve Injury

ISSN: 1749-7221