Objective To observe the outcome of healthy C7 nerve root transfer through the anterior spinal approach to repair the brachial plexus avulsion. Methods The healthy C7 nerve root was sectioned at the junction site of trunk and division, the proximal side was dissected to the foramina and transfered behind the posterior aspect of anterior scalenus to the space between the esophagus and cervical vertebrae, then the 4-6 bands of cutaneous nerves were used for bridging the defect between the healthy C7 and recipient nerve to repair the upper trunk or dorsal division of the upper trunk of the injured brachial plexus. From March 2002 to August 2003, 21 patients with brachial plexus avulsion were repaired using this procedure, among which 14 patients (12 males, 2 females) were followed up for more than 12 months. The average age was 31 years with a range of 17 to 41 years. The interval from injury to operation ranged from 2 to 6 months with a mean of 4 months. 14 patients included 5 cases with total brachial plexus avulsion, 8 cases with upper and middle trunk avulsion associated with partial injury of the lower trunk and 1 case with cutting injury of upper and middle trunk. Results The average follow-up duration was 16 months ranging from 12 to 19 months. 9 of the 10 cases who underwent the healthy C7 transfer through the anterior spinal approach to repair the upper trunk, the C5 and C6 nerve roots or the anterior and posterior division of upper trunk achieved at least the MRC grade 3 motor recovery of shoulder abduction and elbow flexion and 1 case failed. 3 cases underwent the healthy C7 transfer to repair the dorsal division of the upper trunk achieved at least the MRC grade 3 motor recovery of shoulder abduction. 1 case who underwent the healthy C7 transfer to repair the C6 nerve root didnt get recovery. Conclusion The result of healthy C7 transfer througth the anterior spinal approach to repair the upper trunk of brachial plexus for restoration of the shoulder abduction and elbow flexion or the function of shoulder abduction in repairing the dorsal division of upper trunk is satisfactory.