Contralateral Obturator to Femoral Nerve Branch Transfer for Multilevel Lumbosacral Plexus Avulsion Injury

Nichols, David Spencer; Chim, Harvey

doi:10.1097/gox.0000000000003997

Cited by 3 publications

(8 citation statements)

References 11 publications

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“…• Suggested that the muscle branches of sciatic nerve may be a reasonable candidate for femoral nerve repair Nicholas et al (2021) [13] • Case report • Reported two cases of extensive lumbosacral plexus injury accompanied with root avulsion which underwent contralateral obturator-to-femoral neve • At the last follow-up, patients had 3/5 and 2/5 knee extension, representing this nerve transfer as a therapeutic option for extensive plexal injuries Peters et el. (2021) [12] • Retrospective case-series • Reported the functional outcome of 14 patients with femoral nerve palsy that underwent femoral nerve decompression and nerve transfer • Post-operatively, a significant improvement in knee extension muscle power and pain compared with preoperation (P-value = 0.001) Lubelski et al (2021) [16] • Case-series • Demonstrated sciatic-to-femoral nerve transfer using a fascicle of the proximal tibial nerve as the donor for pediatric patients with acute flaccid paralysis…”

Section: Femoral Nerve Repairmentioning

confidence: 99%

“…One of the most robust data on nerve transfer for femoral nerve repair came from the study by Peters et al [12] . They previously reported success in treating high femoral nerve palsy using the motor branches of the anterior obturator nerve to the gracilis, adductor longus, and adductor brevis muscles and the sartorius motor branches to improve quadriceps function [12] . Successful reinnervation to all four quadriceps muscles has been reported in cases where the zone of injury was inaccessible, such as after hip surgery [12] .…”

Section: Peroneal Nerve Repairmentioning

confidence: 99%

“…They previously reported success in treating high femoral nerve palsy using the motor branches of the anterior obturator nerve to the gracilis, adductor longus, and adductor brevis muscles and the sartorius motor branches to improve quadriceps function [12] . Successful reinnervation to all four quadriceps muscles has been reported in cases where the zone of injury was inaccessible, such as after hip surgery [12] . In this example, femoral nerve decompression was offered in conjunction with nerve transfer surgery as an adjunct therapy for neuropathic pain [12] .…”

Section: Peroneal Nerve Repairmentioning

confidence: 99%

“…Successful reinnervation to all four quadriceps muscles has been reported in cases where the zone of injury was inaccessible, such as after hip surgery [12] . In this example, femoral nerve decompression was offered in conjunction with nerve transfer surgery as an adjunct therapy for neuropathic pain [12] .…”

Section: Peroneal Nerve Repairmentioning

confidence: 99%

“…Nerve transfers have the possibility of earlier reinnervation with restoration of function [11] . Anatomical and clinical studies have investigated new sites for nerve transfers and reported promising results in traumatic cases [12][13][14] and patients with acute flaccid myelitis [15,16] . The variability of lower extremity nerve injuries requires a personalized approach and understanding of each therapy's unique advantages and disadvantages.…”

Section: Introductionmentioning

confidence: 99%

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Advances in lower extremity peripheral nerve surgery

Garbuzov¹,

Shekouhi²,

Nichols³

et al. 2023

Plast Aesthet Res

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Peripheral nerve injury (PNI) is a common source of pain and disability in patients. While many patients are affected by PNI, peripheral nerve surgery advancements in the lower extremity have lagged behind the upper extremity. Subsequently, principles that have demonstrated success in the upper extremity have been implemented in the lower extremity. Interventions with recent advances include the advent of novel nerve transfers in the lower extremity and using stem cells and electrical stimulation (ES) for nerve regeneration. This article focuses on advances in nerve transfers for lower extremity PNI and provides details on the basic science and clinical applications of newer interventions.

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Section: Femoral Nerve Repairmentioning

confidence: 99%

Section: Peroneal Nerve Repairmentioning

confidence: 99%

Section: Peroneal Nerve Repairmentioning

confidence: 99%

Section: Peroneal Nerve Repairmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Advances in lower extremity peripheral nerve surgery

Garbuzov¹,

Shekouhi²,

Nichols³

et al. 2023

Plast Aesthet Res

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Surgical Interventions for Lumbosacral Plexus Injuries: A Systematic Review

Nichols

Fenton

Cox

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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Background: Nerve reconstruction techniques for lumbosacral plexus (LSP) injuries vary. There are no clear treatment guidelines available, and summative evaluations of the literature discussing these surgeries are lacking. For these reasons, this investigation aimed to systematically review and consolidate all available literature discussing surgical interventions for LSP injuries and cohesively present patient-reported and objective postoperative outcomes. Methods: The authors conducted a systematic review using PubMed, Embase, Web of Science, ProQuest Dissertations and Theses Global (via Proquest.com), and ClinicalTrials.gov databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. After title and abstract screening, identified articles were read in full and selected for inclusion based on prespecified criteria. Results: Our literature search identified 8683 potential citations, and after duplicate removal, abstract screening, and full-text review, 62 studies remained meeting inclusion and exclusion criteria. Outcomes were extracted according to the location of injury and type of surgical repair. Injuries were classified into isolated femoral nerve injuries, isolated obturator nerve injuries, isolated sciatic nerve injuries, and multilevel LSP injuries. Surgical treatment was further classified into exploration with neurolysis, direct repair, nerve grafting, and nerve transfer surgery. Conclusions: Although results vary based on the location of the injury and the surgical technique used, nerve grafts and transfers demonstrated reasonable success in improving functional and pain outcomes. Overall, isolated femoral and obturator nerve injuries had the best outcomes reported with surgical treatment. Furthermore, incomplete sciatic nerve and multilevel LSP injuries had more reported surgical options and better outcomes than complete sciatic nerve injuries.

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Peripheral nerve transfers for dysfunctions in central nervous system injuries: a systematic review

Xiang,

Wu,

et al. 2024

International Journal of Surgery

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Background: The review highlights recent advancements and innovative uses of nerve transfer surgery in treating dysfunctions caused by central nervous system (CNS) injuries, with a particular focus on spinal cord injury (SCI), stroke, traumatic brain injury, and cerebral palsy. Methods: A comprehensive literature search was conducted regarding nerve transfer for restoring sensorimotor functions and bladder control following injuries of spinal cord and brain, across PubMed and Web of Science from January 1920 to May 2023. Two independent reviewers undertook article selection, data extraction, and risk of bias assessment with several appraisal tools, including the Cochrane Risk of Bias Tool, the JBI Critical Appraisal Checklist, and SYRCLE’s ROB tool. The study protocol has been registered and reported following PRISMA and AMSTAR guidelines. Results: Nine hundred six articles were retrieved, of which 35 studies were included (20 on SCI and 15 on brain injury), with 371 participants included in the surgery group and 192 in the control group. These articles were mostly low-risk, with methodological concerns in study types, highlighting the complexity and diversity. For SCI, the strength of target muscle increased by 3.13 of Medical Research Council grade, and the residual urine volume reduced by more than 100 ml in 15 of 20 patients. For unilateral brain injury, the Fugl-Myer motor assessment (FMA) improved 15.14–26 score in upper extremity compared to 2.35–26 in the control group. The overall reduction in Modified Ashworth score was 0.76–2 compared to 0–1 in the control group. Range of motion (ROM) increased 18.4–80° in elbow, 20.4–110° in wrist and 18.8–130° in forearm, while ROM changed −4.03°−20° in elbow, −2.08°−10° in wrist, −2.26°−20° in forearm in the control group. The improvement of FMA in lower extremity was 9 score compared to the presurgery. Conclusion: Nerve transfer generally improves sensorimotor functions in paralyzed limbs and bladder control following CNS injury. The technique effectively creates a ‘bypass’ for signals and facilitates functional recovery by leveraging neural plasticity. It suggested a future of surgery, neurorehabilitation and robotic-assistants converge to improve outcomes for CNS.

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Contralateral Obturator to Femoral Nerve Branch Transfer for Multilevel Lumbosacral Plexus Avulsion Injury

Cited by 3 publications

References 11 publications

Advances in lower extremity peripheral nerve surgery

Advances in lower extremity peripheral nerve surgery

Surgical Interventions for Lumbosacral Plexus Injuries: A Systematic Review

Peripheral nerve transfers for dysfunctions in central nervous system injuries: a systematic review

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