Functional outcome predictors after spinal accessory nerve to suprascapular nerve transfer for restoration of shoulder abduction in traumatic brachial plexus injuries in adults: the effect of time from injury to surgery

Abstract

Background Shoulder abduction is crucial for daily activities, and its restoration is one of the surgical priorities. We evaluated the predictive factors of shoulder abduction functional outcome after spinal accessory nerve (SAN) to suprascapular nerve (SSN) transfer, with special emphasis on the effect of time from injury to the surgery, in the treatment of traumatic brachial plexus injuries. Method This cohort included adult patients who underwent SAN-to-SSN transfer with a preoperative Medical Research Council strength grade 0 and a follow-up of minimum 18 months. The primary outcome was shoulder abduction function (bad, < 30°; good, 30°-60°; or excellent, > 60°). Demographics, trauma characteristics, time lapse between injury and surgery, concomitant axillary nerve reconstruction, and surgery duration were registered. Ordinal logistic regression was used to identify predictors of functional outcomes. Results The records of 83 patients (86.7% men, mean age 28.8 ± 9.8 years) were analysed. Mean body mass index was 24.1 ± 3.7 kg/m 2 , and 43.1% were overweight/obese. Motorcycle crashes were the most common trauma mechanism (88.0%). Excellent, good, and bad outcomes were achieved by 20.4%, 38.6%, and 41.0%, respectively. Older patients tended to have worse outcomes (p = 0.074), as well as left-sided lesions (p = 0.015) or those contralateral to manual dominance (p = 0.057). The longer the interval between injury and surgery the worse the outcome: excellent, 5.5 (4.3-7.1); good, 6.9 (5.9-8.7); and bad, 8.2 (5.7-10.1) months (p = 0.018). After multivariable analysis, longer time interval predicted lower odds of better outcomes (OR 0.823, 95% CI 0.699-0.970, p = 0.020; 17.7% lower odds of good or excellent outcome for each additional month). The odd of good or excellent outcomes was also associated with axillary nerve reconstruction (OR 2.767, 95% CI 1.016-7.536, p = 0.046), but not with age or lesion laterality. Conclusions Excellent or good functional outcomes for shoulder abduction were achieved by almost sixty percent of adults who underwent SAN-to-SSN transfer for reconstruction of traumatic brachial plexus injuries, associated or not with axillary nerve reconstruction strategies. Longer delays from injury to surgery predicted worse outcomes, and the best time frame seemed to be less than 6 months.

Posterior division of ipsilateral C7 transfer to C5 for shoulder abduction limitation

“…In addition, there are other factors that contribute to different outcomes of neurogenic shoulder function improvement, such as the interval between injury and surgery ( 18 ), age, and BMI ( 19 ), thus, future studies should examine these factors in greater detail. In our study, we applied PDIC7 transfer to the C5 root in patients aged 16–63 years and the interval between injury and surgery was 1–9 months.…”

Double Fascicular Nerve Transfer Restored Nearly Normal Functional Movements in a Completely Paralyzed Upper Extremity Resulting from an ACDF Surgery: A Case Report and Review of Recent Literature

“…Addressing nerve root injuries in the context of severe cervical spinal cord injuries resulting in complete paralysis of the extremities has been challenging. Distal-targeted nerve transfers have been successfully performed as a preferred alternative to the site of a proximal injury [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] since the regeneration distance will be much shorter and, therefore, the recovery will be faster. Additionally, in cases of iatrogenic surgical injuries at the proximal cervical spinal level (ACDF), as in the present case report, the distal operative area will have no scarring from previous surgeries, allowing for technical precision in reconstructive efforts.…”

“…Fasce et al [ 22 ] reported that patients under age 25 years have better outcomes due to their higher regenerative capability. Solla et al [ 24 ] reported that older patients had worse outcomes. However, our patient was older (45 years) but still achieved all UE functions 17 months after the nerve transfer surgery, as she had external and internal neurolysis of the involved nerve fascicles and release of muscle contractures.…”

“…Solla et al [ 24 ] reported that their patients shoulder abduction improvements were excellent (>60°) and good (>40°) after SAN to SSN, whether they were associated with axillary nerve reconstruction strategies or not, respectively. Four patients who had SAN to SSN combined with radial to axillary nerve transfer demonstrated a statistically significant increase in the range of abduction (median, 90° vs 42.5°, respectively) compared with those who had SAN to SSN transfer alone.…”

Comparison of Anterior vs. Dorsal Approach for Spinal Accessory to Suprascapular Nerve Transfer in Patients With a Brachial Plexus Injury and Its Outcome on Shoulder Function

“…Brachial plexus injuries are commonly seen secondary to birth-related trauma or from trauma secondary to a fall, most commonly in a road traffic accident [1][2][3][4]. Injuries involving the upper trunk brachial plexus, i.e., C5, C6, C7 roots, lead to significant disability of shoulder function with loss of shoulder abduction and range of motion.…”