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Hyperselective neurectomy of thoracodorsal nerve for treatment of the shoulder spasticity: anatomical study and preliminary clinical results

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Abstract

Background

Hyperselective neurectomy is a reliable treatment for spasticity. This research was designed to quantify the surgical parameters of hyperselective neurectomy of thoracodorsal nerve for shoulder spasticity through anatomical studies, as well as to retrospectively assess patients who underwent this procedure to provide an objective basis for clinical practice.

Methods

On nine embalmed adult cadavers (18 shoulders), we dissected and observed the branching patterns of thoracodorsal nerve, counted the number of nerve branches, measured the distribution of branch origin point, and determined the length of the surgical incision. Next, we selected five patients who underwent this procedure for shoulder spasticity and retrospectively evaluated (ethic committee: 2022–37) their shoulder function with active/passive range of motion (AROM/PROM) and modified Ashworth scale (MAS).

Results

The anatomical study revealed that the main trunk of thoracodorsal nerve sends out one to three medial branches, with the pattern of only one medial branch being the most common (61.1%); there were significant variations in the branch numbers and nerve distributions; the location of thoracodorsal nerve branches’ entry points into the muscle varied from 27.2 to 67.8% of the length of the arm. Clinical follow-up data showed significant improvement in shoulder mobility in all patients. AROM of shoulder abduction increased by 39.4° and PROM increased by 64.2° (P < 0.05). AROM and PROM of shoulder flexion increased by 36.6° and 54.4°, respectively (P < 0.05). In addition, the MAS of shoulder abduction (1.8) and flexion (1.2) was both significantly reduced in all patients (P < 0.05).

Conclusion

Hyperselective neurectomy of thoracodorsal nerve is effective and stable in the treatment of shoulder spasticity. Intraoperative attention is required to the numbers of the medial branch of thoracodorsal nerve. We recommend an incision in the mid-axillary line that extends from 25 to 70% of the arm length to fully expose each branch.

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Data availability

The original contributions presented in the study are included in the article/supplementary material; further inquiries can be directed to the corresponding author.

Abbreviations

AROM:

Active range of motion

PROM:

Passive range of motion

MAS:

Modified Ashworth scale

HSN:

Hyperselective neurectomy

References

  1. Bini N, Leclercq C (2020) Anatomical study of the deep branch of the ulnar nerve and application to selective neurectomy in the treatment of spasticity of the first web space. Surg Radiol Anat 42:253–258

    Article  PubMed  Google Scholar 

  2. Bohannon RW, Smith MB (1987) Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther 67:206–207

    Article  CAS  PubMed  Google Scholar 

  3. Brunelli G, Brunelli F (1983) Partial selective denervation in spastic palsies (hyponeurotization). Microsurgery 4:221–224

    Article  CAS  PubMed  Google Scholar 

  4. Buffenoir K, Rigoard P, Ferrand-Sorbets S, Lapierre F (2009) Retrospective study of the long-term results of selective peripheral neurotomy for the treatment of spastic upper limb. Neurochirurgie 55(Suppl 1):S150–S160

    Article  PubMed  Google Scholar 

  5. Buffenoir K, Decq P, Hamel O, Lambertz D, Perot C (2013) Long-term neuromechanical results of selective tibial neurotomy in patients with spastic equinus foot. Acta Neurochir (Wien) 155:1731–1743

    Article  PubMed  Google Scholar 

  6. Cambon-Binder A, Leclercq C (2015) Anatomical study of the musculocutaneous nerve branching pattern: application for selective neurectomy in the treatment of elbow flexors spasticity. Surg Radiol Anat 37:341–348

    Article  PubMed  Google Scholar 

  7. Decq P, Filipetti P, Feve A, Djindjian M, Saraoui A, Kéravel Y (1997) Peripheral selective neurotomy of the brachial plexus collateral branches for treatment of the spastic shoulder: anatomical study and clinical results in five patients. J Neurosurg 86:648–653

    Article  CAS  PubMed  Google Scholar 

  8. Delgado MR, Tilton A, Carranza-Del Río J, Dursun N, Bonikowski M, Aydin R, Maciag-Tymecka I, Oleszek J, Dabrowski E, Grandoulier A, Picaut P (2021) Efficacy and safety of abobotulinumtoxin A for upper limb spasticity in children with cerebral palsy: a randomized repeat-treatment study. Dev Med Child Neurol 63:592–600

    Article  PubMed  Google Scholar 

  9. Garland DE, Thompson R, Waters RL (1980) Musculocutaneous neurectomy for spastic elbow flexion in non-functional upper extremities in adults. J Bone Joint Surg Am 62:108–112

    Article  CAS  PubMed  Google Scholar 

  10. Gracies J, Brashear A, Jech R, McAllister P, Banach M, Valkovic P, Walker H, Marciniak C, Deltombe T, Skoromets A, Khatkova S, Edgley S, Gul F, Catus F, De Fer BB, Vilain C, Picaut P (2015) Safety and efficacy of abobotulinumtoxin A for hemiparesis in adults with upper limb spasticity after stroke or traumatic brain injury: a double-blind randomised controlled trial. Lancet Neurol 14:992–1001

    Article  CAS  PubMed  Google Scholar 

  11. Gras M, Leclercq C (2017) Spasticity and hyperselective neurectomy in the upper limb. Hand Surg Rehabil 36:391–401

    Article  CAS  PubMed  Google Scholar 

  12. Helin M, Bachy M, Stanchina C, Fitoussi F (2018) Pronator teres selective neurectomy in children with cerebral palsy. J Hand Surg Eur 43:879–884

    Article  Google Scholar 

  13. Iwanaga J, Singh V, Ohtsuka A, Hwang Y, Kim H, Moryś J, Ravi KS, Ribatti D, Trainor PA, Sañudo JR, Apaydin N, Şengül G, Albertine KH, Walocha JA, Loukas M, Duparc F, Paulsen F, Del Sol M, Adds P, Hegazy A, Tubbs RS (2021) Acknowledging the use of human cadaveric tissues in research papers: recommendations from anatomical journal editors. Clin Anat 34:2–4

    Article  PubMed  Google Scholar 

  14. Iwanaga J, Singh V, Takeda S, Ogeng’O J, Kim H, Moryś J, Ravi KS, Ribatti D, Trainor PA, Sañudo JR, Apaydin N, Sharma A, Smith HF, Walocha JA, Hegazy AMS, Duparc F, Paulsen F, Del Sol M, Adds P, Louryan S, Fazan VPS, Boddeti RK, Tubbs RS (2022) Standardized statement for the ethical use of human cadaveric tissues in anatomy research papers: recommendations from Anatomical Journal Editors-in-Chief. Clin Anat 35:526–528

    Article  PubMed  Google Scholar 

  15. Koman LA, Smith BP, Shilt JS (2004) Cerebral palsy. Lancet 363:1619–1631

    Article  PubMed  Google Scholar 

  16. Koman LA, Smith BP, Williams R, Richardson R, Naughton M, Griffin L, Evans P (2013) Upper extremity spasticity in children with cerebral palsy: a randomized, double-blind, placebo-controlled study of the short-term outcomes of treatment with botulinum A toxin. J Hand Surg Am 38:435–446

    Article  PubMed  Google Scholar 

  17. Kong KH, Chua KS (1999) Neurolysis of the musculocutaneous nerve with alcohol to treat poststroke elbow flexor spasticity. Arch Phys Med Rehabil 80:1234–1236

    Article  CAS  PubMed  Google Scholar 

  18. Kwakkel G, Meskers CGM (2015) Botulinum toxin A for upper limb spasticity. Lancet Neurol 14:969–971

    Article  PubMed  Google Scholar 

  19. Leclercq C (2003) General assessment of the upper limb. Hand Clin 19:557–564

    Article  PubMed  Google Scholar 

  20. Leclercq C (2018) Selective neurectomy for the spastic upper extremity. Hand Clin 34:537–545

    Article  PubMed  Google Scholar 

  21. Lee K (2007) Variation of the spinal nerve compositions of thoracodorsal nerve. Clin Anat 20:660–662

    Article  PubMed  Google Scholar 

  22. Lee H, Chen JJ, Wu Y, Wang Y, Huang S, Piotrkiewicz M (2008) Time course analysis of the effects of botulinum toxin type a on elbow spasticity based on biomechanic and electromyographic parameters. Arch Phys Med Rehabil 89:692–699

    Article  PubMed  Google Scholar 

  23. Lu W, Xu J, Wang D, Gu Y (2008) Microanatomical study on the functional origin and direction of the thoracodorsal nerve from the trunks of brachial plexus. Clin Anat 21:509–513

    Article  PubMed  Google Scholar 

  24. Maarrawi J, Mertens P, Luaute J, Vial C, Chardonnet N, Cosson M, Sindou M (2006) Long-term functional results of selective peripheral neurotomy for the treatment of spastic upper limb: prospective study in 31 patients. J Neurosurg 104:215–225

    Article  PubMed  Google Scholar 

  25. Msaddi AK, Mazroue AR, Shahwan S, Al Amri N, Dubayan N, Livingston D, Moutaery KR (1997) Microsurgical selective peripheral neurotomy in the treatment of spasticity in cerebral-palsy children. Stereotact Funct Neurosurg 69:251–258

    Article  CAS  PubMed  Google Scholar 

  26. Paolini G, Longo B, Laporta R, Sorotos M, Amoroso M, Santanelli F (2013) Permanent latissimus dorsi muscle denervation in breast reconstruction. Ann Plast Surg 71:639–642

    Article  CAS  PubMed  Google Scholar 

  27. Parot C, Leclercq C (2016) Anatomical study of the motor branches of the median nerve to the forearm and guidelines for selective neurectomy. Surg Radiol Anat 38:597–604

    Article  PubMed  Google Scholar 

  28. Paulos R, Leclercq C (2015) Motor branches of the ulnar nerve to the forearm: an anatomical study and guidelines for selective neurectomy. Surg Radiol Anat 37:1043–1048

    Article  PubMed  Google Scholar 

  29. Pecak F, Trontelj JV, Dimitrijevic MR (1980) Scoliosis in neuromuscular disorders. Int Orthop 3:323–328

    Article  CAS  PubMed  Google Scholar 

  30. Penn RD, Kroin JS (1985) Continuous intrathecal baclofen for severe spasticity. Lancet 2:125–127

    Article  CAS  PubMed  Google Scholar 

  31. Purohit AK, Raju BS, Kumar KS, Mallikarjun KD (1998) Selective musculocutaneous fasciculotomy for spastic elbow in cerebral palsy: a preliminary study. Acta Neurochir (Wien) 140:473–478

    Article  CAS  PubMed  Google Scholar 

  32. Rousseaux M, Buisset N, Daveluy W, Kozlowski O, Blond S (2009) Long-term effect of tibial nerve neurotomy in stroke patients with lower limb spasticity. J Neurol Sci 278:71–76

    Article  PubMed  Google Scholar 

  33. Sindou MP, Simon F, Mertens P, Decq P (2007) Selective peripheral neurotomy (SPN) for spasticity in childhood. Childs Nerv Syst 23:957–970

    Article  CAS  PubMed  Google Scholar 

  34. Sitthinamsuwan B, Chanvanitkulchai K, Phonwijit L, Nunta-Aree S, Kumthornthip W, Ploypetch T (2013) Surgical outcomes of microsurgical selective peripheral neurotomy for intractable limb spasticity. Stereotact Funct Neurosurg 91:248–257

    Article  PubMed  Google Scholar 

  35. Stoffel A (1913) The treatment of spastic contractures. Am J Orthop Surg 10:611–644

    Google Scholar 

  36. Waxweiler C, Remy S, Merlini L, Leclercq C (2022) Nerve transfer in the spastic upper limb: anatomical feasibility study. Surg Radiol Anat 44:183–190

    Article  PubMed  Google Scholar 

  37. Yu A, Shen Y, Qiu Y, Jiang S, Yu Y, Yin H, Xu W (2020) Hyperselective neurectomy in the treatment of elbow and wrist spasticity: an anatomical study and incision design. Br J Neurosurg 9:1–6

    Article  CAS  Google Scholar 

  38. Zhao J, Zhao Q, Liu Z, Deng S, Cheng L, Zhu W, Zhang R, Ma R, Yan H, Li Q (2020) The anatomical mechanism of C5 palsy after expansive open-door laminoplasty. Spine J 20:1776–1784

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors sincerely thank those who donated their bodies to science so that anatomical research could be performed. Results from such research can potentially increase mankind’s overall knowledge that can then improve patient care. Therefore, these donors and their families deserve our highest gratitude [3]. The authors thank all the participants and researchers who participated in this study.

Funding

This work was supported by the National Natural Science Foundation of China under Grants 81830063, 81801363, 81873766, and 82021002; CAMS Innovation Fund for Medical Sciences under Grant 2019-I2M-5–007; Special Project of Clinical and Translational Medicine Research Cultivating Program under Grant 2021-I2M-C&T-B-100; Program of Shanghai Municipal Commission of Health and Family Planning under Grant 20184Y0111; Shanghai Municipal Clinical Medical Center Project under Grant 2017ZZ01006; and Shanghai Municipal Key Clinical Specialty under Grant shslczdzk05601.

Author information

Authors and Affiliations

  1. Department of Hand Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China

    Weishan Lin, Tie Li, Wenjun Qi, Yundong Shen & Wendong Xu

  2. Department of Hand and Upper Extremity Surgery, Limb Function Reconstruction Center, Jing’an District Central Hospital, Shanghai, China

    Weishan Lin, Tie Li, Wenjun Qi, Yundong Shen & Wendong Xu

  3. National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China

    Tie Li, Yundong Shen & Wendong Xu

  4. Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, China

    Tie Li, Yundong Shen & Wendong Xu

  5. Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China

    Tie Li, Yundong Shen & Wendong Xu

  6. State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China

    Tie Li, Yundong Shen & Wendong Xu

  7. Research Unit of Synergistic Reconstruction of Upper and Lower Limbs After Brain Injury, Chinese Academy of Medical Sciences, Shanghai, China

    Tie Li, Yundong Shen & Wendong Xu

  8. Shanghai Engineering Research Center of Artificial Intelligence Medical Auxiliary Equipment, Shanghai, China

    Tie Li, Yundong Shen & Wendong Xu

  9. Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China

    Tie Li, Yundong Shen & Wendong Xu

Authors
  1. Weishan Lin
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  2. Tie Li
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  3. Wenjun Qi
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  4. Yundong Shen
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  5. Wendong Xu
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Contributions

Each author made substantial contributions to this work. Weishan Lin and Yundong Shen contributed to the conception and design of the work. Weishan Lin and Tie Li contributed to the acquisition of the study data. Weishan Lin and Tie Li contributed to the analysis and interpretation of the data. Wendong Xu, Yundong Shen, and Weishan Lin contributed to the surgical technical support. Weishan Lin and Tie Li contributed to the drafting of the manuscript. Wendong Xu, Yundong Shen, and Wenjun Qi contributed to the revision of the manuscript. All authors approved the submitted version. Weishan Lin and Tie Li contributed equally to this work.

Corresponding author

Correspondence to Yundong Shen.

Ethics declarations

Ethics approval

The procedures used in this study adhere to the tenets of the Declaration of Helsinki. The studies involving human participants were reviewed and approved by the ethics committee of Jing’an District Central Hospital (Jing’an Branch of Huashan Hospital) (Approved No. of ethic committee: 2022–37). Written informed consent from the participants was not required to participate in this study in accordance with the national legislation and the institutional requirements.

Conflict of interest

The authors declare no competing interests.

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Comments

Hyperselective neurectomy (HSN) for the treatment of spasticity is adequately proved by Leclercq et al. to be the effected choice of treatment for shoulder spasticity in order to improve passive and active range of movement. This study confirms with further five operated cases the efficacy of HSN. It also contributes with anatomical study of thoracodorsal nerve branches and measurements to orient the surgeon intraoperatively.

Ridvan Alimehmeti.

Tirana, Albania.

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Lin, W., Li, T., Qi, W. et al. Hyperselective neurectomy of thoracodorsal nerve for treatment of the shoulder spasticity: anatomical study and preliminary clinical results. Acta Neurochir 165, 1179–1188 (2023). https://doi.org/10.1007/s00701-023-05553-2

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