Accessory Nerve to Suprascapular Nerve Transfer to Restore Shoulder Exorotation in Otherwise Spontaneously Recovered Obstetric Brachial Plexus Lesions

Ouwerkerk, W. J. R. van; Uitdehaag, Bernard M. J.; Strijers, R.L.M.; Nollet, Frans; Höll, K.; Fellner, Franz A.

doi:10.1227/01.neu.0000232988.46219.e4

Cited by 32 publications

(22 citation statements)

References 24 publications

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“…Reportan buenos resultados con recuperación de la RE del hombro neurotizando el nS en niños solo sin recuperación de la RE. 29 Terzis y Kokalis 15 obtuvieron mejores resultados en pacientes operados antes de los 6 meses de vida, y consideran que una neurotización intraplexual del tronco posterior, en particular del nervio axilar, es fundamental para mejorar los resultados. Trazando un paralelismo con la patología del adulto, Bertelli y Ghizoni comunican también mejores resultados cuando reconstruyen el tronco primario superior y el tronco posterior, probablemente por reinervación de músculos accesorios y antagonistas.…”

Section: Discussionunclassified

Parálisis obstétrica del plexo braquial: resultados preliminares de la transferencia del nervio espinal accesorio al nervio supraescapular en 10 casos. [Accessory nerve to suprascapular nerve transfer in obstetrical brachial plexus palsy: preliminary results in 10 cases.]

Valbuena¹

2015

Rev. Asoc. Arg. Ort. y Traumatol

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113 ResumenObjetivo: Evaluar los resultados preliminares en 10 casos de transferencias del nervio espinal accesorio al nervio supraescapular en parálisis obstétricas del plexo braquial. Materiales y Métodos: Entre 2010 y 2012, se realizaron 16 transferencias del nervio espinal accesorio al nervio supraescapular en parálisis obstétricas del plexo braquial. Se incluyeron 10 casos con un seguimiento mínimo de 18 meses. Se evaluó la fuerza muscular del hombro según la escala de Gilbert y se usaron escalas funcionales de Mallet y de Gilbert. Se compararon valores preoperatorios y posoperatorios, así como las diferencias entre parálisis de tipo parcial y total. Se usó la prueba de Student para valorar la significancia estadística de los datos. Resultados: El seguimiento promedio fue de 20.9 meses. Se hallaron valores medios preoperatorios de fuerza de abducción de 0,48 M, y posoperatorios de 2,70 M; los valores de rotación externa preoperatorios fueron de 0 M y, al final del seguimiento, de 2,4 M. Todos los pacientes mostraban patrones preoperatorios de tipo 1 tanto de la escala de Mallet como la de Gilbert, con valores posoperatorios promedio de 3,2 y 3,5, respectivamente. Se hallaron diferencias estadísticamente significativas entre estos valores. Conclusiones: Esta serie presenta valores preliminares con un seguimiento corto y su principal crítica es el bajo número de casos. Los resultados funcionales obtenidos coinciden con los de otros reportes, y avalan su uso en las reconstrucciones del plexo braquial que requieran aporte extraplexual. were assessed according to the Gilbert scale, and functional scales of the shoulder (Mallet and Gilbert) were used. Preoperative and postoperative values, and the differences between partial and total paralysis results were compared. Student test was used for the statistical analysis. Results:The average follow-up was 20.9 months. Preoperative shoulder abduction power was 0.48 M, preoperative external rotation power was 0 M, and those values at the end of the follow-up were 2.70 M and 2.4 M, respectively. All patients had type 1 patterns of the Gilbert and Mallet scales, with mean postoperative values of 3.2 and 3.5, respectively. Statistically significant differences were found between these values. Conclusions: Limitations of this preliminary report are the short follow-up and the low number of cases. However, the functional results obtained are consistent with those from other reports, and they support the use of the spinal accessory nerve to suprascapular nerve transfer in brachial plexus reconstructions requiring an extra-plexual contribution.

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Section: Discussionunclassified

Parálisis obstétrica del plexo braquial: resultados preliminares de la transferencia del nervio espinal accesorio al nervio supraescapular en 10 casos. [Accessory nerve to suprascapular nerve transfer in obstetrical brachial plexus palsy: preliminary results in 10 cases.]

Valbuena¹

2015

Rev. Asoc. Arg. Ort. y Traumatol

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“…Following the description of Kawabata and colleagues [9] of the use of the spinal accessory nerve as an ipsilateral nerve transfer to the suprascapular nerve in infants with upper brachial plexus birth injuries, its use has continued to expand. Total the scores for active abduction/forward flexion and active external rotation; from [7] a Maximum shoulder score=10; decrease score by 1 point for a contracture >20°T Several groups [1,6,8,11,14,19,20] have published variable experiences with the use of the distal SAN-to-SSN transfer as part of a primary or secondary plexus reconstruction in infants who fail to demonstrate spontaneous recovery of active shoulder external rotation following a period of observation. In a retrospective review of 86 infants, Pondaag et al [14] found similar clinical results and functional scores in infants undergoing C5-to-SSN bypass grafting (n=65) and those who received direct SANto-SSN (n=21) transfers performed at a mean of 5 months of age.…”

Section: Discussionmentioning

confidence: 99%

Outcome Following Spinal Accessory to Suprascapular (Spinoscapular) Nerve Transfer in Infants with Brachial Plexus Birth Injuries

Ruchelsman

Ramos

Alfonso

et al. 2009

Hand (New York, N,Y.)

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The purpose of this study is to evaluate the value of distal spinal accessory nerve (SAN) transfer to the suprascapular nerve (SSN) in children with brachial plexus birth injuries in order to better define the application and outcome of this transfer in these infants. Over a 3-year period, 34 infants with brachial plexus injuries underwent transfer of the SAN to the SSN as part of the primary surgical reconstruction. Twenty-five patients (direct repair, n=20; interposition graft, n=5) achieved a minimum follow-up of 24 months. Fourteen children underwent plexus reconstruction with SAN-to-SSN transfer at less than 9 months of age, and 11 underwent surgical reconstruction at the age of 9 months or older. Mean age at the time of nerve transfer was 11.6 months (range, 5-30 months). At latest follow-up, active shoulder external rotation was measured in the arm abducted position and confirmed by review of videos. The Gilbert and Miami shoulder classification scores were utilized to report shoulder-specific functional outcomes. The effects of patient age at the time of nerve transfer and the use of interpositional nerve graft were analyzed. Overall mean active external rotation measured 69.6°; mean Gilbert score was 4.1 and the mean Miami score was 7.1, corresponding to overall good shoulder functional outcomes. Similar clinical and shoulder-specific functional outcomes were obtained in patients undergoing early (<9 months of age, n=14) and late (>9 months of age, n=11) SAN-to-SSN transfer and primary plexus reconstruction. Nine patients (27%) were lost to follow-up and are not included in the analysis. Optimum results were achieved following direct transfer (n=20). Results following the use of an interpositional graft (n=5) were rated satisfactory. No patient required a secondary shoulder procedure during the study period. There were no postoperative complications. Distal SAN-to-SSN (spinoscapular) nerve transfer is a reliable option for shoulder reinnervation in infants with brachial plexus birth injuries. Direct transfer seems to be the optimum method. The age of the patient does not seem to significantly impact on outcome.

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“…Nerve transfers can be directed toward the suprascapular nerve or the axillary nerve [17,18,22,[24][25][26][27][28][29][30][31][32][33]. In the flail shoulder, the author prefers to perform both nerve transfers to maximize shoulder motion.…”

Section: Nerve Transfers For Shoulder Motionmentioning

confidence: 99%

“…Most of the nerve transfer results in children have addressed shoulder motion [32,33,43]. Kawabata and colleagues [32] reported on 13 spinal accessory nerve transfers to various targets.…”

Section: Outcomes Of Nerve Transfersmentioning

confidence: 99%

“…van Ouwerkerk and colleagues [33] reported on late suprascapular nerve transfer performed as a separate procedure at a mean age of 21.7 months in 54 children. Preoperative MRI scans showed only minor wasting of spinatus muscles, intraoperative stimulation of suprascapular nerves elicited spinatus muscle reaction in 44 out of 48 patients, and histology of suprascapular nerves was normal.…”

Section: Outcomes Of Nerve Transfersmentioning

confidence: 99%

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Nerve Transfers in Brachial Plexus Birth Palsies: Indications, Techniques, and Outcomes

Kozin

2008

Hand Clinics

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Accessory Nerve to Suprascapular Nerve Transfer to Restore Shoulder Exorotation in Otherwise Spontaneously Recovered Obstetric Brachial Plexus Lesions

Cited by 32 publications

References 24 publications

Parálisis obstétrica del plexo braquial: resultados preliminares de la transferencia del nervio espinal accesorio al nervio supraescapular en 10 casos. [Accessory nerve to suprascapular nerve transfer in obstetrical brachial plexus palsy: preliminary results in 10 cases.]

Parálisis obstétrica del plexo braquial: resultados preliminares de la transferencia del nervio espinal accesorio al nervio supraescapular en 10 casos. [Accessory nerve to suprascapular nerve transfer in obstetrical brachial plexus palsy: preliminary results in 10 cases.]

Outcome Following Spinal Accessory to Suprascapular (Spinoscapular) Nerve Transfer in Infants with Brachial Plexus Birth Injuries

Nerve Transfers in Brachial Plexus Birth Palsies: Indications, Techniques, and Outcomes

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