Nerve transfers for restoration of upper extremity motor function in a child with upper extremity motor deficits due to transverse myelitis: Case report

Dorsi, Michael J.; Belzberg, Allan J.

doi:10.1002/micr.20939

Cited by 16 publications

(5 citation statements)

References 15 publications

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“…Comparing the results of published literature using the abovementioned potential donor nerves demonstrates that using the ulnar nerve (Oberlin procedure) is associated with better outcomes. 19 Satisfactory outcomes of the Oberlin procedure in patients with acute flaccid myelitis 20 and transverse myelitis 21 support the idea that this procedure can also be helpful in iatrogenic cervical nerve root injuries.…”

Section: Reconstruction Of Elbow Flexionmentioning

confidence: 85%

Iatrogenic Cervical Nerve Root Injury After Spine Surgery: How Nerve Surgeons Can Assist Spine Surgeons

Emamhadi

Dogahe²,

Emamhadi³

2022

Int J Spine Surg

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Background: Iatrogenic cervical nerve root injury may occur during cervical spine surgeries, which leads to upper limb palsy. The question of how a permanent iatrogenic upper limb palsy would be managed remains unclear. Recent developments of nerve transfer have led to a considerable interest in its applications. This study outlines a new reconstructive approach forupper limb palsy following cervical spine surgery using nerve transfer.Methods: In an attempt to reconstruct iatrogenic upper limb palsy, we performed nerve transfer in 4 patients with permanently lost functions. Medical Research Council Scale for Muscle Strength was used to assess muscle strength. Electromyography was performed to assess the reinnervation of the target muscles.Results: All patients underwent surgery between 7 and 12 months after primary injury. Spinal accessory nerve to suprascapular nerve transfer with or without transferring the long head of triceps branch of the radial nerve to anterior branch of the axillary nerve was used to reconstruct shoulder abduction in 2 patients. Double fascicular nerve transfer (a fascicle of the ulnar nerve to biceps branch and a fascicle of the median nerve to brachialis branch of the musculocutaneous nerve) was used to reconstruct elbow flexion in 3 patients. One patient had lost both his elbow flexion and shoulder abduction. After a mean of 10 months of follow-up, all patients improved to a muscle strength of M4 without donor deficit .Conclusion: In our view, these results represent an excellent initial step toward the treatment of iatrogenic nerve root injury after spine surgery.Level of Evidence: 4.

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Section: Reconstruction Of Elbow Flexionmentioning

confidence: 85%

Iatrogenic Cervical Nerve Root Injury After Spine Surgery: How Nerve Surgeons Can Assist Spine Surgeons

Emamhadi

Dogahe²,

Emamhadi³

2022

Int J Spine Surg

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“…3,6 At present, there are no known mechanisms for reversing this pathology and contemporary case series indicate that patients frequently experience significant, persistent neurological deficit. 3,5 We postulate that for these severely disabled patients, that do not demonstrate improvement, nerve transfer procedures-similar to those affected by traumatic spinal cord injury 19 and transverse myelitis 20 -may be an option to restore function. Here, we describe transferring sciatic nerve fascicles to the femoral nerve as an option for restoring motor function.…”

Section: Discussionmentioning

confidence: 99%

Sciatic-to-Femoral Nerve End-to-End Coaptation for Proximal Lower Extremity Function in Patients With Acute Flaccid Myelitis: Technical Note and Review of the Literature

Lubelski¹,

Pennington²,

Tuffaha³

et al. 2021

Operative Surg.

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BACKGROUND Acute flaccid myelitis (AFM) is an acute-onset anterior horn disease resulting in flaccid paralysis of extremities, trunk, facial, and cervical musculature in children following upper respiratory or gastrointestinal viral illness. Nerve transfer procedures have been shown to restore function. OBJECTIVE To present a technical description of sciatic-to-femoral nerve transfers in 4 children with AFM. METHODS Retrospective review of relevant cases was performed. RESULTS A total of 4 cases are presented of young children with persistent quadriparesis in the setting of AFM, presenting between 4 and 15 mo following initial diagnosis. Electromyography showed denervation of muscles innervated by the femoral nerve, with sparing of the sciatic distribution. The obturator nerve was also denervated in all patients. We therefore elected to pursue sciatic-to-femoral transfers to restore active knee extension. These transfers involved end-to-end coaptation of a sciatic nerve fascicle to the femoral nerve motor branches supplying quadriceps muscles. CONCLUSION We present technical descriptions of bilateral sciatic-to-femoral nerve neurotization for the restoration of quadriceps function in 4 patients with AFM. The sciatic nerve fascicles are a reasonable alternative donor nerve for patients with proximal muscle paralysis and limited donor options in the lower extremity.

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“…Similar to traumatic brachial plexus injuries a nerve transfer to restore active elbow flexion has been successfully used in obstetric brachial plexus palsies in the recent decade, in avulsions as well as upper trunk lesion neuroma‐in‐continuity (Figueiredo Rde, Grechi, & Gepp Rde, ; Noaman, Shiha, & Bahm, ). In nontraumatic conditions, nerve transfer to restore active elbow flexion has been reported in cases of transverse myelitis (Dorsi & Belzberg, ) and poliomyelitis‐like syndrome combining a nerve transfer with a free muscle transfer (Hattori, Doi, & Baliarsing, ) and flaccid myelitis (Wolfe, ). In cases of AMC it has been published by Bahm () and reported by this author (Hagemann, ).…”

Section: Discussionmentioning

confidence: 99%

“…We recommend to apply it after tension-free sutures with 10-0 monofilic and do not rely on fibrin glue alone, unlike others.Similar to traumatic brachial plexus injuries a nerve transfer to restore active elbow flexion has been successfully used in obstetric brachial plexus palsies in the recent decade, in avulsions as well as upper trunk lesion neuroma-in-continuity(Figueiredo Rde, Grechi, & Gepp Rde, 2016;Noaman, Shiha, & Bahm, 2004). In nontraumatic conditions, nerve transfer to restore active elbow flexion has been reported in cases of transverse myelitis(Dorsi & Belzberg, 2012) and…”

mentioning

confidence: 99%

Nerve transfer from the median to musculocutaneous nerve to induce active elbow flexion in selected cases of arthrogryposis multiplex congenita

et al. 2019

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Background Arthrogryposis multiplex congenita (AMC) is a rare disease which affects mainly upper and lower extremities. Affected patients are not able to eat unassisted due to elbow contracture and nonexistent active elbow flexion. In traumatic brachial plexus palsies, a nerve transfer from either median or ulnar nerve to the musculocutaneous nerve has proved to induce active elbow flexion, and we report our results of such a procedure in a nontraumatic condition, that is, arthrogryposis. Methods We selected four patients with AMC type 1 (6 extremities, 2 males, 2 females) diagnosed with AMC presenting to our institution shortly after birth from 2014 to 2016 to perform a nerve transfer from the median nerve to the musculocutaneous nerve in order to induce active elbow flexion. The indication of application of this surgical procedure was based on active finger and wrist flexion, limited contracture of elbow joints and evidence of flexing muscle fibers detected by sonography. Results Five nerve transfers were conducted with a follow up of 2–5 years. Two extremities reached active elbow flexion motorgrade M4, two M3, and one M1 at latest follow up. One patient developed a postoperative suture granuloma. One nerve transfer was abandoned due to neuroanatomic variation. One extremity was treated with botulinum toxin in triceps muscle in addition to the nerve transfer. Conclusions In this series of selected cases of AMC Type 1 we were able to induce active elbow flexion using a nerve transfer technique developed for traumatic and obstetric brachial plexus palsies. In four extremities the procedure achieved independent hand‐to‐mouth active elbow flexion. Level of evidence four.

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Nerve transfers for restoration of upper extremity motor function in a child with upper extremity motor deficits due to transverse myelitis: Case report

Cited by 16 publications

References 15 publications

Iatrogenic Cervical Nerve Root Injury After Spine Surgery: How Nerve Surgeons Can Assist Spine Surgeons

Iatrogenic Cervical Nerve Root Injury After Spine Surgery: How Nerve Surgeons Can Assist Spine Surgeons

Sciatic-to-Femoral Nerve End-to-End Coaptation for Proximal Lower Extremity Function in Patients With Acute Flaccid Myelitis: Technical Note and Review of the Literature

Nerve transfer from the median to musculocutaneous nerve to induce active elbow flexion in selected cases of arthrogryposis multiplex congenita

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