Abstract
Objective
To evaluate the transfer of the spinal accessory nerve to the suprascapular nerve through the anterior or posterior approach in patients with late traumatic brachial plexus injuries.
Methods
This study includes patients with late brachial plexus injuries that underwent a spinal accessory-to-suprascapular nerve transfer. They were divided into two equal groups, A and B, in which the spinal accessory nerve was transferred to the suprascapular nerve, respectively, through the anterior or posterior approach. Narakas’s scale for assessment of the abduction of the arm and rotation of the shoulder was used.
Results
We studied 20 male patients with an age ranging from 18 to 42 years. In groups A and B, the mean age was 28 ± 5.5 and 26 ± 7.7 years, respectively. The time interval between injury and surgery was 9.5 ± 1.6 and 10.9 ± 2.5 months for groups A and B (p = 0.12), respectively. In the 20 patients in groups A and B, we obtained a strength of shoulder abduction at 30°, respectively, M3 (in 4 and 5), M2 (in 4 and 2), M1 (in 2 and 2) and M0 (in zero and 1) (p = 0.5). Regarding external rotation, group A showed M2 in only one patient and M0 in nine, while in group B, M3, in four; M2, in three; and M0, in three. In group B, the best results were observed in relation to the recovery of external rotation (p = 0.008).
Conclusions
Better results in terms of external arm rotation were obtained when spinal accessory-to-suprascapular nerve transfer was performed using the posterior approach.
References
Alnot JY, Rostoucher P, Oberlin C, Touam C (1998) C5-C6 and C5-C6-C7 traumatic paralysis of the brachial plexus of the adult caused by supraclavicular lesions. Rev Chir Orthop Reparatrice Appar Mot 84:113–123
Bertelli JA, Ghizoni MF (2004) Reconstruction of C5 and C6 brachial plexus avulsion injury by multiple nerve transfers: spinal accessory to suprascapular, ulnar fascicles to biceps branch, and triceps long or lateral head branch to axillary nerve. J Hand Surg [Am] 29:131–139
Bhandari PS, Sadhotra LP, Bhargava P, Bath AS, Mukherjee MK, Bhatti TS, Maurya S (2008) Multiple nerve transfers for the reanimation of shoulder and elbow functions in irreparable C5, C6 and upper truncal lesions of the brachial plexus. Indian J Neurotrauma 5:95–104
Bhandari PS, Sadhotra LP, Bhargava P, Singh M, Mukherjee MK, Bhatoe HS (2010) Dorsal approach in spinal accessory to suprascapular nerve transfer in brachial plexus injuries: technique details. Indian J Neurotrauma\ 7:71–74
Birch R (2011) Repair of the roots of the spinal nerves in an avulsion lesion. The spinal accessory nerve. In: Surgical disorders of the peripheral nerves, 2nd edition. London: Springer-Verlag, pp 264–5
Colbert SH, Mackinnon S (2006) Posterior approach for double nerve transfer for restoration of shoulder function in upper brachial plexus palsy. Hand 1:71–77
Flores LP (2008) Suprascapular nerve release for treatment of shoulder and periscapular pain following intracranial spinal accessory nerve injury. J Neurosurg 109:962–966
Guan SB, Hou CL, Chen DS, Gu YD (2006) Restoration of shoulder abduction by transfer of the spinal accessory nerve to suprascapular nerve through dorsal approach: a clinical study. Chin Med J (Engl) 119:707–712
Kim DH, Murovic JA, Tiel RL, Kline DG (2004) Mechanisms of injury in operative brachial plexus lesions. Neurosurg Focus 16:E2
Leechavengvongs S, Witoonchart K, Uerpairojkit C, Thuvasethakul P, Ketmalasiri W (1998) Nerve transfer to biceps muscle using part of the ulnar nerve in brachial plexus injury (upper arm type): a report of 32 cases. J Hand Surg [Am] 23:711–716
Leechavengvongs S, Witoonchart K, Uerpairojkit C, Thuvasethakul P (2003) Nerve transfer to deltoid muscle using the nerve to the long head of the triceps, part II: a report of 7 cases. J Hand Surg [Am] 28:633–638
Narakas AO (1995) Examen du patient et de la fonction des divers groupes musculaires du membre supérieur. In: Alnot JY, Narakas AO (eds) Les paralysies du plexus brachial, 2nd edn. Expansion Scientifique Française, Paris, pp 52–67
Oberlin C, Béal D, Leechavengvongs S, Salon A, Dauge MC, Sarcy JJ (1994) Nerve transfer to biceps muscle using part of ulnar nerve for C5–C6 avulsion of the brachial plexus: anatomical study and report of four cases. J Hand Surg [Am] 19:232–237
Sulaiman OA, Kim DD, Burkett C, Kline DG (2009) Nerve transfer surgery for adult brachial plexus injury: a 10-year experience at Louisiana State University. Neurosurgery 65(4 Suppl):A55–A62
Venkatramani H, Bhardwaj P, Reza-Faruquee S, Raja-Sabapathy S (2008) Functional outcome of nerve transfer for restoration of shoulder and elbow function in upper brachial plexus injury. J Brachial Plex Peripher Nerve Inj 3:15
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Souza, F.H.M., Bernardino, S.N., Filho, H.C.A. et al. Comparison between the anterior and posterior approach for transfer of the spinal accessory nerve to the suprascapular nerve in late traumatic brachial plexus injuries. Acta Neurochir 156, 2345–2349 (2014). https://doi.org/10.1007/s00701-014-2222-6
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DOI: https://doi.org/10.1007/s00701-014-2222-6