257 Lateral Branches of C2 and C3 Dorsal Rami for Neurotization Following Brachial Plexus Injuries: An Anatomical Feasibility Study

INTRODUCTION: Brachial plexus injuries can have a devastating impact on a patient’s quality of life. Thus, surgeons continue to seek out possible donors for neurotization. In the cervical spine, the lateral branches of C2 and C3 dorsal rami are predominately motor nerves that have not been thoroughly studied for brachial plexus repair. METHODS: One fresh frozen and three formalin-fixed cadavers (8 sides) were placed in the prone position for the initial dissection. Via a suboccipital approach, the lateral branches of C2 and C3 dorsal rami were exposed and followed to their termination into regional muscles. The nerves were measured and marked. Next, the specimens were placed supine, and the C5 nerve root, superior trunk, phrenic nerve, and suprascapular nerve were exposed. The previously transected ends of the C2 and C3 dorsal rami lateral branches were tunneled and connected to these structures. RESULTS: Six of the eight lateral branches (75%) of C2 and C3 nerves were long enough (approx. 5-5.5 cm) to be directly transposed to the C5 nerve root, superior trunk, phrenic nerve, and suprascapular nerve tension-free. A sural nerve graft was used to bridge the gap on the two sides where the lateral branch was not long enough. CONCLUSIONS: Based on our study in cadaveric specimens, the lateral branches of C2 and C3 dorsal rami can be used as tension-free direct nerve transfers for brachial plexus neurotization procedures. A sural nerve graft may be used when the nerve is not long enough for a direct transfer.