India [Harvard Medical-Affiliated & USA Joint Commission-Accredited Hospitals]
Brachial plexus surgery in India is a very affordable surgery with the same quality of medical care, as available in the US, UK, Canada, or any other developed country.
The brachial plexus is a group of nerves originating from the spinal cord. These nerves are mainly responsible for movement and sensation of the arm and hand. Brachial plexus injuries are very serious and can cause partial or complete loss of function or sensation of the involved upper extremity. Brachial plexus injuries can happen either because of trauma (accident) or obstetric causes.According to the book Skeletal Injury in the Child by John Anthony Ogden, R. N. Hensinger, N. McCullough, it was earlier believed that brachial plexus injuries were more common in large neonates, but, the complication has been reported even in normal size neonates.”
According to the book Skeletal Injury in the Child by John Anthony Ogden, R. N. Hensinger, N. McCollough, ”(Although it was earlier believed that brachial plexus injuries were more common in large neonates) the complication has been reported even in normal size neonates.”
Brachial plexus injury complicates 0.6-2.6 per 1,000 live births, according to the paper ‘A Systematic Review of Brachial Plexus Surgery for Birth-Related Brachial Plexus Injury’ by P. Daniel McNeely, and James M. Drake.
In adults, motorcycle accidents, pedestrian accidents, industrial accidents and gunshot wounds are usually responsible for injury of the brachial plexus. Sportspersons are also susceptible to brachial plexus injury.
What Happens During Brachial Plexus Surgery?
First, the surgeon will fully explore the nerve network. If there is scar tissue (neuroma) present, it will need to be cleared. The surgery is deemed to be over if the nerve works well once this is completed. This is called a neurolysis.
Nerve grafts may be required on some children. Nerves are then transplanted, usually from the leg (sural nerve) to reconnect the damaged nerves. After the surgery, an immobilizer is put on the arm, so that it does not shift out more than 45 degrees. This allows the surgery site to heal. The wrap must be worn for four weeks.
Brachial plexus surgery needs the involvement of a neurosurgeon, pediatric plastic surgeon, and a pediatric neurologist performing intra-operative EMG.
History of Brachial Plexus Surgery
Brachial plexus surgery has a long history. At the beginning of the 20th century, some pioneering surgeons like Kennedy, Thorburn, Fairbank, Gilmour, Lange, Spitzy, Tuttle and Taylor took on the highly difficult task of repairing the damaged brachial plexus in infants and also adults.
In the 1960s, micro-surgical methods were introduced. This made the whole approach more aggressive: it changed from a ‘wait and see’ stand to ‘see and repair’. Current developments like cervical myelography, CT-myelography, and MRI have hugely improved the amount of knowledge we can get regarding the extent and severity of brachial plexus damage.
Who Qualifies for Brachial Plexus Surgery?
A baby or an adult who has suffered extensive damage to the brachial plexus, is in need of the surgery. Some patients do recover without surgery. Qualifying patients will demonstrate the following symptoms:
- Good or moderate use of their fingers, but little or no control over the muscles of shoulder and elbow.
- Can use their arm, but have little or no control of the fingers.
- Completely flaccid limb with no sensory or motor functions.
How to Prepare for Brachial Plexus Surgery?
You may want to set up appointments with your pediatrician and specialists one month prior to surgery to discuss specific pre-surgery, intra-operative and post-surgery needs. Here are some facts that will help you to mentally gear up for the surgery:
- A nerve conduction study (EMG or electromyography test) may be required before the surgery.
- The surgery will take from 4 to 12 hours.
- If your child needs to have an EMG, (possibly a difficult test) you might want to plan something fun and distractive for immediately afterwards.
- The MRI scanning is non-invasive. It is an upright scan done without anesthesia.
- Your child must not take any aspirin, aspirin products, Vitamin E or herbal products three weeks before surgery.
- One week prior to surgery, if your child has a fever, congestion, sore throat, cough, rash, allergic reaction, exposure to chicken pox or other childhood disease, you will need to report it to the surgeon and take the steps recommended.
Preparations at home after Brachial Plexus Surgery
- Have these things ready: incision dressing changes, alcohol gel for disinfection, sterile gauze pads, easy-to-remove medical tape, Tylenol, etc.
- The first few sponge-bathing sessions can be a bit challenging. It would be good if you can arrange for someone to help you through them.
- Check your child’s sleep area. Try to see if he/she will be ok at home in his/her crib or bed, as he/she will have a large splint after the operation. Some children sleep well after surgery and some don’t. Keeping extra pillows ready may help.
Advantages of Brachial Plexus Surgery
The advantages of brachial plexus surgery are, of course, that the normal functions are restored, which will in the future contribute to your child’s self-confidence and social acceptance.
Disadvantages of Brachial Plexus Surgery
Some disadvantages or possible risks of brachial plexus surgery include:
- Infection, additional paralysis, diaphragm paralysis, fluid in the lung, artery damage, and reactions to anesthesia. These risks are quite rare, but do occur. Your surgeon will talk about all these to you in detail well ahead of the surgery. The risks depend on the nerve operated and the method of repair. If only a nerve transfer is performed, these risks are much reduced.
- Weakness in strength associated with adduction (a gravity-assisted motion) and internal rotation.
- The scar will gradually fade, but will remain visible.
You must call your doctor if any of the following symptoms are observed:
- Warmth, redness, or swelling around the incision
- Drainage from the incision
Post-operative care for Brachial Plexus Surgery
Recovery is slow after brachial plexus surgery. Results of the surgery are seen in six to eight months and strength continues to improve over the next two to three years. Another EMG is sometimes required if the recovery is slower than expected to confirm that the nerves are growing in the right direction and are restoring function.
- After the surgery, the patient will stay in the hospital for a couple of days.
- As the recovery process is usually painless or involves little pain for adults, the same is usually expected for children. However, pain medication is given if there is any pain.
- The patient’s arm will be in a sling after surgery to prevent movement. This helps to manage the pain as well.
- While your child is in the hospital after the surgery, one parent must stay with the child at all times. Usually, a daybed is provided so the parent can stay overnight.
- Adult patients are encouraged to engage in light activity at home. They can get back to routine activities such as showering, driving, walking up stairs, and work within a few days after surgery. If you are taking narcotic medications for pain, you should not drive.
- Physical therapy is a must and begins about two weeks after surgery.
Affordable Brachial Plexus Surgery in India
Brachial plexus surgery is a very complex procedure and requires expert surgeons. Hence, it can be very expensive. But there are cheaper alternatives available in India. The cost of brachial plexus surgery in India is 60-70% lesser than that in the US. Even when you add other costs like accommodation, the price still remains attractive.
Apart from the huge savings, the other benefits to be got from brachial plexus surgery in India are specialized service and high standards of medical care. The tourist hospitals in India have cutting edge technology, that is required for this complex procedure.
Brachial plexus surgery in India can make a huge difference to the patient’s lifestyle and comfort in doing his daily activities.
Brachial Plexus Surgeons in India
Dr Sajan Hegde: Dr Hegde was the first Indian to receive the prestigious Cotrel Spine Fellowship. He has pioneered the use of many modern instrumentation systems, for example, the Cotrel-Dubousset, the Moss Miami, and the Ray cages (PLIF), BAK cages and the Harms Mesh Systems in India.
Dr. D V Rajakumar: Dr Rajakumar is a leading neurosurgeon with more than twenty years experience in complex spine procedures. Minimal access surgical approaches to neurological diseases are his forte.
Dr. K.N. Krishnan: His specialty is complex spine surgeries from cranio-vertebral junction to lumbo sacral region including global (anterior & posterior) decompressions, fusions and internal stabilization procedures for spinal trauma, tumors and infections.
Dr Yash Gulati: Educated in India and the UK, Dr Gulati performs various types of spine surgery including minimally invasive spine surgery like micro discectomies, and spine stabilization.
Medical Tourism Corporation facilitates low cost brachial plexus surgery at world class hospitals in India. Use the estimate form on this page to request a free quote and more information.