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Possible donor nerves for axillary nerve reconstruction in dual neurotization for restoring shoulder abduction in brachial plexus injuries: a systematic review and meta-analysis

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Abstract

Restoring shoulder abduction is one of the main priorities in the surgical treatment of brachial plexus injuries. Double nerve transfer to the axillary nerve and suprascapular nerve is widely used and considered the best option. The most common donor nerve for the suprascapular nerve is the spinal accessory nerve. However, donor nerves for axillary nerve reconstructions vary and it is still unclear which donor nerve has the best outcome. The aim of this study was to perform a systematic review on reconstructions of suprascapular and axillary nerves and to perform a meta-analysis investigating the outcomes of different donor nerves on axillary nerve reconstructions. We conducted a systematic search of English literature from March 2001 to December 2020 following PRISMA guidelines. Two outcomes were assessed, abduction strength using the Medical Research Council (MRC) scale and range of motion (ROM). Twenty-two studies describing the use of donor nerves met the inclusion criteria for the systematic review. Donor nerves investigated included the radial nerve, intercostal nerves, medial pectoral nerve, ulnar nerve fascicle, median nerve fascicle and the lower subscapular nerve. Fifteen studies that investigated the radial and intercostal nerves met the inclusion criteria for a meta-analysis. We found no statistically significant difference between either of these nerves in the abduction strength according to MRC score (radial nerve 3.66 ± 1.02 vs intercostal nerves 3.48 ± 0.64, p = 0.086). However, the difference in ROM was statistically significant (radial nerve 106.33 ± 39.01 vs. intercostal nerve 80.42 ± 24.9, p < 0.001). Our findings support using a branch of the radial nerve for the triceps muscle as a donor for axillary nerve reconstruction when possible. Intercostal nerves can be used in cases of total brachial plexus injury or involvement of the C7 root or posterior fascicle. Other promising methods need to be studied more thoroughly in order to validate and compare their results with the more commonly used methods.

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Data availability

Not applicable.

Code availability

R version 4.0.4 was used to perform statistical analysis, citation: R Core Team (2021). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. URL https://www.R-project.org/.

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Funding

The study was supported by the Charles University Prague, project GA UK No. 176221 and Progres Q37.

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Authors and Affiliations

  1. Department of Plastic Surgery, Third Faculty of Medicine, Charles University and University Hospital Královské Vinohrady, Prague, Czech Republic

    Michal Makeľ & Andrej Sukop

  2. Department of Anatomy, First Faculty of Medicine, Charles University, Prague, Czech Republic

    Michal Makeľ

  3. Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic

    David Kachlík & Adam Whitley

  4. Department of Anaesthesia and Intensive Care Medicine, Third Faculty of Medicine, Charles University and University Hospital Královské Vinohrady, Prague, Czech Republic

    Petr Waldauf

  5. Department of General Surgery, Third Faculty of Medicine, Charles University and University Hospital Královské Vinohrady, Prague, Czech Republic

    Adam Whitley

  6. Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital Prague, Prague, Czech Republic

    Radek Kaiser

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  1. Michal Makeľ
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  2. Andrej Sukop
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Contributions

Michal Makel—author of the manuscript

Andre Sukop—study supervisor and consultant

David Kachlík—provided critical revision for important intellectual content

Petr Waldauf—performed statistical analysis of data

Adam Whitley–participated on data collection and statistical analysis.

Radek Kaiser—conceived and designed the study

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Correspondence to Michal Makeľ.

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Makeľ, M., Sukop, A., Kachlík, D. et al. Possible donor nerves for axillary nerve reconstruction in dual neurotization for restoring shoulder abduction in brachial plexus injuries: a systematic review and meta-analysis. Neurosurg Rev 45, 1303–1312 (2022). https://doi.org/10.1007/s10143-021-01713-z

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  • DOI: https://doi.org/10.1007/s10143-021-01713-z

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