Back to 2025 Abstracts
Taking a Closer Look into the Utility of Horner's Syndrome in Surgical Evaluation in Brachial Plexus Birth Injury.
Clark Jia-Long Chen, MD
1; Christopher S Crowe, MD
2; Connor Hickey, MD
3; Eugene D Park, MD
4; Scott H Kozin, MD
5; Dan A. Zlotolow, MD
51Einstein Healthcare Network, Philadelphia, PA; 2University of Washington, Seattle, WA; 3Albert Einstein Healthcare Network, Philadelphia, PA; 4Shriners Children's Philadelphia, Philadelphia, PA; 5Shriners Hospitals for Children, Philadelphia, PA
Introduction:
Horner's syndrome (HS), characterized by ptosis, miosis, and anhidrosis, has been associated with severe injury of the lower trunk due to the proximity of the sympathetic chain. Clinicians using the Narakas classification of brachial plexus birth injury (BPBI) have previously reported poor outcome for spontaneous recovery in the setting of HS. However, anatomical studies show that there are consistent sympathetic contributions ofC7 unique to infants. In this study we characterize the clinical significance of HS in BPBI using preoperative and postoperative functional outcomes.
Materials and methods:
A total of 164 patients underwent brachial plexus exploration with autograft reconstruction between 2004 to 2023. Intraoperative injury findings were tabulated into the following patterns: A (C5, C6), B (C5, C6, C7), C (C5, C6, C7, C8), D (C5, C6, C7, C8, T1). Avulsion and ruptures of the nerve roots were noted. HS and preoperative Active Motion Scale (AMS) scores were evaluated at initial consultation. Postoperative AMS scores were recorded at the time of follow-up. Patients with and without Horner's syndrome were stratified based on injury patterns and compared on the basis of AMS scores.
Results:
There were 55 patients with and 107 patients without HS. Of those with HS, 5 had intraoperative A, B, or C injuries. A comparison cohort of 46 patients with Injury D without Horner's and 50 patients with Injury D with Horner's were identified. There was no statistical difference between comparison groups (p=0.673), nor between any variation of lower trunk nerve root avulsions (Table 1). Secondary analysis showed was more common in Injury D than A/B/C injuries (p<0.001). On the other hand, there was no difference between HS and avulsion verses rupture of C7 nerve root (p=0.675). Addition of partial ruptures to ruptures did not produce significance (p=0.141) (Table 2).
Conclusions:
There is no association between pre- or postoperative AMS score and HS. There was not a specific avulsion or rupture injury pattern in patients with HS. Consideration of Horner's syndrome in brachial plexus birth injury is not a useful factor in evaluating preoperative severity or postoperative outcomes.
Back to 2025 Abstracts
