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Long-term clinical outcomes of spinal accessory nerve transfer to the suprascapular nerve in patients with brachial plexus palsy

  • Clinical Article - Functional
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Abstract

Background

For the reconstruction of brachial plexus lesions, restoration of elbow flexion and shoulder function is fundamental and is achieved by dual nerve transfers. Shoulder stabilization and movement are crucial in freedom of motion of the upper extremity. In patients with C5-C6 brachial plexus injury, spinal accessory nerve transfer to the suprascapular nerve and a fascicle of ulnar nerve to musculocutaneous nerve (dual nerve transfer) are carried out for restoration of shoulder abduction and elbow flexion, respectively. In the present study, we evaluated the long-term clinical outcomes of spinal accessory nerve transfer to the suprascapular nerve for restoration of shoulder abduction in patients with brachial plexus palsy undergoing a dual nerve transfer.

Patients and methods

In the present retrospective review, 22 consecutive subjects with upper brachial plexus palsy were assessed. All of the subjects underwent spinal accessory nerve transfer to the suprascapular nerve and a dual nerve transfer from the ulnar nerve to the biceps branch and from the median nerve to the brachialis branch of the musculocutaneous nerve simultaneously. All of the subjects were followed up for 18 to 24 months (average, 21.7 months) for assessing the recovery of the shoulder abduction and motor function.

Results

Spinal accessory nerve transfer to the suprascapular nerve showed a motor function recovery of M3 and M4 in 13.6 and 63.6% of the subjects, respectively. However, 22.7 % of the subjects remained with a motor function of M2. The mean of shoulder abduction reached 55.55 ± 9.95° (range, 40–72°). Altogether, good functional results regained in 17 out of 22 the subjects (77.2 %). Linear regression analysis showed that advanced age was a predictor of low motor functional grade.

Conclusions

The evidence from the present study suggests that transferring spinal accessory nerve to the suprascapular nerve for restoring shoulder abduction is an effective and reliable treatment with high success rate in patients with brachial plexus palsy, especially in young patients.

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Authors and Affiliations

  1. Brachial Plexus and Peripheral Nerve Injury Center, Guilan University of Medical Science, Rasht, Iran

    Mohammadreza Emamhadi

  2. Department of Neurosurgery, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran

    Babak Alijani & Sasan Andalib

Authors
  1. Mohammadreza Emamhadi
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  2. Babak Alijani
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  3. Sasan Andalib
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Corresponding author

Correspondence to Babak Alijani.

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Funding

No funding was received for this research.

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this retrospective study, formal consent is not required.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Comment

An interesting and solid paper that looks at the success rate of neurotizing the suprascapular nerve with a distal spinal accessory nerve branch. The results fall in line with the results of others who have published in this area. Although this article does not add anything new to the literature on nerve repair, it is nevertheless reassuring to have confirmatory findings on a nerve procedure that is relatively common in the setting of severe proximal brachial plexus injuries involving avulsion of the C5 and C6 spinal nerve roots.

Michel Kliot

Illinois, USA

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Emamhadi, M., Alijani, B. & Andalib, S. Long-term clinical outcomes of spinal accessory nerve transfer to the suprascapular nerve in patients with brachial plexus palsy. Acta Neurochir 158, 1801–1806 (2016). https://doi.org/10.1007/s00701-016-2886-1

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  • DOI: https://doi.org/10.1007/s00701-016-2886-1

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