Efficacy and Safety of Oberlin's Procedure in the Treatment of Brachial Plexus Birth Palsy

Siqueira, Mário G.; Socolovsky, Mariano; Heise, Carlos Otto; Martins, Roberto S.; Masi, Gilda Di

doi:10.1227/neu.0b013e318271ee4a

Cited by 39 publications

(27 citation statements)

References 20 publications

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“…First considered a "salvage procedure" for use when roots are avulsed and not available for grafting, the procedure has transformed over the years into a first-line procedure for biceps reinnervation in adults and is being increasingly used in children. 44,54,59 One big reason for the popularity of the so-called Oberlin procedure is the high success rate of 90% or greater. One variation in the original technique, which increases the number of axons reaching the agonist target muscles (e.g., double transfers from ulnar to biceps and median to brachialis nerves) has generated even better results; between 95% and 99% of patients experience a good result.…”

Section: Plasticity In Distal Nerve Transfers In Relation To Adjacencmentioning

confidence: 99%

Current concepts in plasticity and nerve transfers: relationship between surgical techniques and outcomes

Socolovsky

Malessy

Lopez

et al. 2017

FOC

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OBJECTIVE Neuroplasticity is analyzed in this article as the capacity of the CNS to adapt to external and internal stimuli. It is being increasingly recognized as an important factor for the successful outcome of nerve transfers. Better-known factors are the number of axons that cross the coaptation site, the time interval between trauma and repair, and age. Neuroplasticity is mediated initially by synaptic and neurotransmitter changes. Over time, the activation of previously existing but lowly active connections in the brain cortex contributes further. Dendritic sprouting and axonal elongation might also take place but are less likely to be prominent. METHODS The authors reviewed different factors that play roles in neuroplasticity and functional regeneration after specific nerve transfers. RESULTS The authors found that these different factors include, among others, the distance between cortical areas of the donor and receptor neurons, the presence versus absence of preexisting lowly active interneuronal connections, gross versus fine movement restoration, rehabilitation, brain trauma, and age. CONCLUSIONS The potential for plasticity should be taken into consideration by surgeons when planning surgical strategy and postoperative rehabilitation, because its influence on results cannot be denied.

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Section: Plasticity In Distal Nerve Transfers In Relation To Adjacencmentioning

confidence: 99%

Current concepts in plasticity and nerve transfers: relationship between surgical techniques and outcomes

Socolovsky

Malessy

Lopez

et al. 2017

FOC

Self Cite

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“…Studies comparing spinal accessory to suprascapular nerve transfer versus C5 nerve grafting show equivalent results [58,59]. Of the patients, 65-90 % demonstrate functional recovery with the Oberlin transfer [60][61][62]. There is insignificant data to assess isolated outcomes of triceps branch to axillary nerve transfer in children, as it is more commonly done in conjunction with other nerve transfers [63].…”

Section: Microsurgical Techniquesmentioning

confidence: 99%

The natural history and management of brachial plexus birth palsy

Buterbaugh

Shah

2016

Curr Rev Musculoskelet Med

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Brachial plexus birth palsy (BPBP) is an upper extremity paralysis that occurs due to traction injury of the brachial plexus during childbirth. Approximately 20 % of children with brachial plexus birth palsy will have residual neurologic deficits. These permanent and significant impacts on upper limb function continue to spur interest in optimizing the management of a problem with a highly variable natural history. BPBP is generally diagnosed on clinical examination and does not typically require cross-sectional imaging. Physical examination is also the best modality to determine candidates for microsurgical reconstruction of the brachial plexus. The key finding on physical examination that determines need for microsurgery is recovery of antigravity elbow flexion by 3-6 months of age. When indicated, both microsurgery and secondary shoulder and elbow procedures are effective and can substantially improve functional outcomes. These procedures include nerve transfers and nerve grafting in infants and secondary procedures in children, such as botulinum toxin injection, shoulder tendon transfers, and humeral derotational osteotomy.

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“…This procedure (Oberlin I) has been frequently used ever since and influenced the development of other intraplexual and extraplexual nerve transfers. Moreover, several case series have reported good functional results of this transfer, both for adult 2,4-10 and obstetric 11,12 upper brachial plexus palsies.…”

Section: Magnetic Resonance Neurographic and Clinical Long-term Resulmentioning

confidence: 94%

Magnetic Resonance Neurographic and Clinical Long-Term Results After Oberlin's Transfer for Adult Brachial Plexus Injuries

Frueh

Schiller

et al. 2017

Annals of Plastic Surgery

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The primary goal of the surgical treatment of upper brachial plexus injuries is to restore active elbow flexion. Accordingly, Oberlin's transfer has been frequently performed since 1994 and has influenced the development of other nerve transfers. However, the window of opportunity for nerve transfers remains a subject of controversy. The objective of this study was to assess magnetic resonance (MR) neurographic, clinical and electrophysiological long-term results after Oberlin's transfer. For this purpose, we performed a retrospective follow-up study. Six patients with upper brachial plexus or musculocutaneous nerve injuries were assessed; 2 were iatrogenic nerve injuries following shoulder arthroscopy or neurofibroma resection. Direct and indirect signs of neuropathy were objectified with MR neurography. Moreover, clinical and electrodiagnostic follow-up was performed and all patients completed the Disabilities of Arm, Shoulder and Hand score. Mean follow-up was 48 ± 21.9 (range, 20-73) months. Mean age was 40 ± 11.3 years and mean delay to surgery was 9 ± 3.2 months. All patients were satisfied with the functional results and the median Disabilities of Arm, Shoulder and Hand score was 21 (range, 1-57). Biceps strength was improved in 5 patients from Medical Research Council grade M0 to M4-5 and in one patient to M2-3. The donor nerve showed normal motor and sensory action potentials. Follow-up MR neurography demonstrated biceps reinnervation. Taken together, this study reports good long-term results after Oberlin's transfer. MR neurography represents an excellent, noninvasive preoperative planning tool and can be of high value in selected postoperative cases. The combined evaluation of nerves and muscles may help to indicate nerve transfers in delayed cases.

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Efficacy and Safety of Oberlin's Procedure in the Treatment of Brachial Plexus Birth Palsy

Abstract: Oberlin's procedure is an effective and safe option for the surgical treatment of upper brachial plexus birth palsy.

Cited by 39 publications

References 20 publications

Current concepts in plasticity and nerve transfers: relationship between surgical techniques and outcomes

Current concepts in plasticity and nerve transfers: relationship between surgical techniques and outcomes

The natural history and management of brachial plexus birth palsy

Magnetic Resonance Neurographic and Clinical Long-Term Results After Oberlin's Transfer for Adult Brachial Plexus Injuries

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