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Object: In this report, the authors review complications related to the modified prespinal route in contralateral C7 transfer for repair the brachial plexus nerve root avulsion injury and suggest prevention strategy.Methods: A retrospective, nonselected amalgamation of every modified contralateral C7 transfer through prespinal route case was undertaken.The study population comprised 425 patients admitted in our clinic center between Feb, 2002 and Aug, 2009.Patients were managed according to a standardized protocol making by one senior professor.The surgical complications were reviewed by several aspects, one involved the tunnel making through the prespinal route, one related to dissection and transection of the contralateral C7 nerve root and the rest occurring in postoperative period.Results: The study population involved 379 males and 46 females, with the average age of 21 years (range from 3 months to 56 years).401 patients were diagnosed as traumatic brachial plexus injury, the leading cause of injury was traffic accident and 24 patients were diagnosis as obstetrical brachial plexus palsy.Contralateral C7 nerve root was cut at the proximal side of division portion of middle trunk in 15 cases, and sectioned at the distal of anterior and posterior divisions in 410 patients.The overall incidence of complications was 5.41% (23/425).The complications associated with the making of prespinal tunnel occurred in 12 cases, including the severe bleeding for vertebral artery injury during the procedure in 2 cases (2/425, 0.47%), temporary recurrent laryngeal nerve palsy in 5 cases (5/425, 1.18%), the pain and numbness on donor upper extremity during swallowing in 4 cases (4/425, 0.94%)and other complication included the dyspnea caused by thrombosis of brain stem in 1 case (0.24%) happened in 42 hours postoperativly, and this patient died in 38 days after the operation.The complications related to the exploration and transection of contralateral C7 nerve root occurred in 11 cases, including the deficiency extensor strength of fingers and thumb in 4 cases (4/425, 0.94%) for the posterior division of lower trnnk injury, and the unbearable pain on donor upper extremity in 3 cases (4/425, 0.71%), Horners syndrome in 2 children (2/425, 0.47%)who suffered birth palsy, and a mistaken section of C6 nerve root as C7 in l ease (0.24%) and sternocostal part of pectoralis major atrophy in 1 case (0.24%).Conclusions: The most serious complications of the modified prespinal route in contralateral C7 transfer were vertebral artery laceration and the posterior division of lower trunk injury.Prevention of such complications is necessary to popularize this surgical procedure and attain good long-term clinical results.