Evaluation of suprascapular nerve neurotization after nerve graft or transfer in the treatment of brachial plexus traction lesions

Malessy, Martijn J. A.; Ruiter, Godard C.W. de; Boer, Kees S. de; Thomeer, R.T.W.M.

doi:10.3171/jns.2004.101.3.0377

Cited by 112 publications

(54 citation statements)

References 30 publications

(27 reference statements)

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“…However, external rotation recovery remains poor in agreement with previous reports. 10,12 We propose 2 possible explanations for the absence of external rotation recovery observed in our patients with complete palsy: 1) The number of myelinated fibers in the accessory nerve is insufficient to match that in the suprascapular nerve (1300 vs 3800, respectively); 10,19 being the first to be reinnervated, the supraspinatus muscle attracts more regenerating axons that the infraspinatus.…”

Section: Discussionmentioning

confidence: 99%

“…However, electromyography findings do not correlate with functional clinical recovery after accessory to suprascapular nerve transfers, as previously demonstrated. 12 In our hands, spinal accessory to suprascapular nerve transfers produce useful recovery in the large majority of patients.…”

Section: Discussionmentioning

confidence: 99%

“…4 Despite the widespread use of this nerve transfer procedure, the results are largely unknown, with some surgeons indicating disappointing results. 12 Based on less-than-ideal results obtained after accessory to suprascapular nerve transfers, a few surgeons have proposed sparing the spinal accessory nerve, thereby preserving trapezius function with the ultimate goal of performing shoulder arthrodesis. 1 In the present paper, we reviewed our 11-year experience performing spinal accessory nerve to suprascapular nerve transfers in 110 patients with complete palsy of the brachial plexus and prolonged follow-up.…”

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Results of spinal accessory to suprascapular nerve transfer in 110 patients with complete palsy of the brachial plexus

Bertelli

Ghizoni

2016

SPI

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OBJECTIVE Transfer of the spinal accessory nerve to the suprascapular nerve is a common procedure, performed to reestablish shoulder motion in patients with total brachial plexus palsy. However, the results of this procedure remain largely unknown. METHODS Over an 11-year period (2002–2012), 257 patients with total brachial plexus palsy were operated upon in the authors' department by a single surgeon and had the spinal accessory nerve transferred to the suprascapular nerve. Among these, 110 had adequate follow-up and were included in this study. Their average age was 26 years (SD 8.4 years), and the mean interval between their injury and surgery was 5.2 months (SD 2.4 months). Prior to 2005, the suprascapular and spinal accessory nerves were dissected through a classic supraclavicular L-shape incision (n = 29). Afterward (n = 81), the spinal accessory and suprascapular nerves were dissected via an oblique incision, extending from the point at which the plexus crossed the clavicle to the anterior border of the trapezius muscle. In 17 of these patients, because of clavicle fractures or dislocation, scapular fractures or retroclavicular scarring, the incision was extended by detaching the trapezius from the clavicle to expose the suprascapular nerve at the suprascapular fossa. In all patients, the brachial plexus was explored and elbow flexion reconstructed by root grafting (n = 95), root grafting and phrenic nerve transfer (n = 6), phrenic nerve transfer (n = 1), or third, fourth, and fifth intercostal nerve transfer. Postoperatively, patients were followed for an average of 40 months (SD 13.7 months). RESULTS Failed recovery, meaning less than 30° abduction, was observed in 10 (9%) of the 110 patients. The failure rate was 25% between 2002 and 2004, but dropped to 5% after the staged/extended approach was introduced. The mean overall range of abduction recovery was 58.5° (SD 26°). Comparing before and after distal suprascapular nerve exploration (2005–2012), the range of abduction recovery was 45° (SD 25.1°) versus 62° (SD 25.3°), respectively (p = 0.002). In patients who recovered at least 30° of abduction, recovery of elbow flexion to at least an M3 level of strength increased the range of abduction by an average of 13° (p = 0.01). Before the extended approach, 2 (7%) of 29 patients recovered active external rotation of 20° and 120°. With the staged/extended approach, 32 (40%) of 81 recovered some degree of active external rotation. In these patients, the average range of motion measured from the thorax was 87° (SD 40.6°). CONCLUSIONS In total palsies of the brachial plexus, using the spinal accessory nerve for transfer to the suprascapular nerve is reliable and provides some recovery of abduction for a large majority of patients. In a few patients, a more extensive approach to access the suprascapular nerve, including, if necessary, dissection in the suprascapular fossa, may enhance outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Results of spinal accessory to suprascapular nerve transfer in 110 patients with complete palsy of the brachial plexus

Bertelli

Ghizoni

2016

SPI

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“…Uno o dos años más tarde, se alcanza el control voluntario gradualmente, aunque el músculo todavía se contrae involuntariamente al toser o al estornudar 58 . Malessy et al 32 , usando imágenes de RM funcionales cerebrales en pacientes en los que se realizó una transferencia exitosa del nervio intercostal para la reinervación del bíceps, observó que la contracción voluntaria del bíceps inducía actividad en la corteza motora primaria.…”

Section: Figura 9 Neurotización Del Nervio Musculocutáneo Con Nerviounclassified

“…Las transferencia nerviosa intraplexual es el procedimiento de elección cuando la lesión del plexo es parcial y por ende están disponibles axones que forman parte del mismo plexo, ya que cualquiera de los nervios donantes ofrece un número de axones mayor que la suma de los axones de todos los nervios disponibles para realizar una transferencia nerviosa extraplexual juntos. En las lesiones completas del plexo braquial, especialmente en los casos de avulsión completa de todas las raíces, las neurotizaciones extraplexuales son la única forma disponible para disminuir el gravísimo déficit que presentan estos infortunados pacientes 3,30,32,37,50,54 . Para realizar una neurotización extraplexual se pueden usar como nervios donantes el nervio espinal accesorio, los nervios intercostales, el nervio frénico, la raíz C7 contralateral y el nervio hipogloso, entre otros.…”

Section: Introductionunclassified

Técnicas de reconstrucción nerviosa en cirugía del plexo braquial traumatizado (Parte 1): Transferencias nerviosas extraplexuales

Robla-Costales¹,

Socolovsky

Masi

et al. 2011

Neurocirugía

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An anatomic study of the spinal accessory nerve: Extended harvest permits direct nerve transfer to distal plexus targets

et al. 2007

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An anatomic study of the distal spinal accessory nerve (SAN) to determine the number of myelinated axons and feasibility of posterior harvest for direct neurotization of distal targets was performed. Ten fresh human cadavers were studied. A supraclavicular approach was performed followed by a posterior approach. The relationship of the SAN to bony landmarks (T1 spinous process, acromioclavicular joint, posterolateral corner of the acromium, and angle at the superior medial border of the scapula) as well as maximal harvestable length was recorded. After posterior dissection, the SAN was mobilized and the ability to reach both anterior infraclavicular and posterior targets was assessed. Axon counts were also performed at the proximal, mid, and distal points along the course of the nerve. The posteriorly harvested SAN was identified reliably with respect to bony landmarks. When harvested posteriorly, the SAN could reach the infraclavicular part of the brachial plexus (i.e., terminal branches), and posteriorly, the suprascapular nerve (SSN) both proximal and distal to the suprascapular ligament, the latter for selective reinnervation of the infraspinatus branch. The average number of myelinated fibers at the proximal end of the nerve was 1,328 axons, at the mid-way point was 1,021 axons, and at terminal end of the nerve was 817 axons. Harvest of the SAN from a posterior approach based on these landmarks is feasible, allowing direct transfer of the nerve to the infraclavicular brachial plexus and to the SSN both proximal and distal to the suprascapular ligament, without the use of interposition nerve grafts. Clin. Anat. 20:899-904, 2007. V V C 2007 Wiley-Liss, Inc.

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Evaluation of suprascapular nerve neurotization after nerve graft or transfer in the treatment of brachial plexus traction lesions

Abstract: The reanimation of shoulder function in patients with proximal C-5 and C-6 brachial plexus traction injuries following suprascapular nerve neurotization is disappointingly low.

Cited by 112 publications

References 30 publications

Results of spinal accessory to suprascapular nerve transfer in 110 patients with complete palsy of the brachial plexus

Results of spinal accessory to suprascapular nerve transfer in 110 patients with complete palsy of the brachial plexus

Técnicas de reconstrucción nerviosa en cirugía del plexo braquial traumatizado (Parte 1): Transferencias nerviosas extraplexuales

An anatomic study of the spinal accessory nerve: Extended harvest permits direct nerve transfer to distal plexus targets

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