Pure Posterior Cord Injury Management: Case Report Study

Abstract

Brachial plexus injuries are common; however, pure posterior cord injuries are rare and present with exclusive clinical manifestations that require specialized surgical approaches to achieve acceptable outcomes. Here, we present our experience with these unique cases. Four patients with lacerated pure posterior cord injuries were included in the study. All cases underwent brachial plexus exploration, and nerve grafts were used for reconstruction. After completing physiotherapy, demographic, medical, and surgical data were collected and evaluated. All four patients were referred due to brachial plexus injury. One patient had sustained a gunshot wound and had undergone arterial reconstruction with a vein graft one week prior. The remaining patients had penetrating injuries. Surgical exploration confirmed pure posterior cord injury in all cases. Sural nerve grafts were used to repair the nerve injuries and bridge the gaps. Patients participated in intensive physiotherapy programs for approximately 12 months, followed by motor and sensory evaluations. Three patients achieved excellent outcomes, while the patient with the gunshot wound had a poor result. There are numerous approaches to managing brachial plexus injuries, including non-surgical treatments, nerve repair, nerve grafting, nerve transfer, and muscle neurotization, depending on the condition and surgeon preference. In cases with clearly defined proximal and distal nerve ends, nerve grafting is preferred. Posterior cord injuries have recognizable clinical manifestations, and appropriate surgical techniques may yield good to excellent outcomes. Although pure posterior cord injuries are rare, meticulous exploration and effective nerve grafting can improve final results.