Neurotization via the Spinal Accessory Nerve in Complete Paralysis Due to Multiple Avulsion Injuries of the Brachial Plexus

Allieu, Y.; Cenac, P

doi:10.1097/00003086-198812000-00011

Cited by 92 publications

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“…Different methods of repair have been described in attempts to regain mobility and sensation, especially for the proximal parts of the affected limb (shoulder and elbow) (2).…”

Section: Discussionmentioning

confidence: 99%

Early post operative results after repair of traumatic brachial plexus palsy

Ahmad

2012

Turkish Neurosurgery

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AIm: Treatment options for traumatic brachial plexus injuries include nerve grafting, or neurotization. The type of lesion and the reconstructive procedures affect functional results and postoperative pain relief. mAterIAl and methOds: A total number of twenty five patients suffering from post-traumatic brachial plexus injury were included in the study. The patients underwent exploration and primary repair of the affected plexus, based on case by case policy.results: Spinal accessory nerve transfer to suprascapular nerve procedure regained 78.95% of functional muscle power, 10.50% of non functional muscle power and only 10.5 % of non innervated muscle. The Oberlin procedure regained 83.33% with elbow flexion muscle power, 16.67% with non functional muscle power. Intercostal nerve transfer to musculocutaneous nerve regained 62.5% with functional muscle power, 25% with non functional muscle power and only 12.5 % with non innervated muscle. The shoulder, elbow and wrist extension functions were significantly improved early post-operatively. In addition, the post-operative improvement of shoulder, elbow and wrist extension functions had significant negative correlations with the pre-operative elapsed time, and accompanied by a significant positive correlation with post-operative follow up period.COnClusIOn: Early intervention for traumatic brachial plexus palsy is recommended to get good results with pain relief. BulGulAr: Supraskapular sinire spinal aksesuar sinir transferi %78,95 işlevsel kas gücü, %10,50 işlevsel olmayan kas gücü ve sadece %10,5 innerve olmayan kas kazandırdı. Oberlin işlemi %83,33 dirsek fleksiyonu kas gücü ve %16,67 işlevsel olmayan kas gücü kazandırdı. Müskülokütanöz sinire interkostal sinir transferi %62,5 işlevsel kas gücü, %25 işlevsel olmayan kas gücü ve sadece%12,55 innerve olmayan kas kazandırdı. Omuz, dirsek ve bilek ekstansiyon işlevleri postoperatif erken dönemde önemli ölçüde düzeldi. Ayrıca, omuz, dirsek ve bilek ekstansiyon işlevlerinin postoperatif düzelmesinin preoperatif geçen süreyle önemli bir negatif korelasyonu bulundu ve postoperatif takip dönemiyle önemli bir pozitif korelasyonu vardı. sOnuÇ: Travmatik brakiyal pleksus palsisinde ağrı giderilmesiyle birlikte iyi sonuçlar alınması için erken girişim önerilir.

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“…Different methods of repair have been described in attempts to regain mobility and sensation, especially for the proximal parts of the affected limb (shoulder and elbow) (2).…”

Section: Discussionmentioning

confidence: 99%

Early post operative results after repair of traumatic brachial plexus palsy

Ahmad

2012

Turkish Neurosurgery

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“…5,6,15,18,19,24 Many techniques and donor nerves have been described, and the most appropriate choice depends on the level of the lesion and the availability of donor motor nerves. 2,11,16,17,20,21 In 1994, Oberlin, et al, 22 reported the transfer of a redundant FCU fascicle from the functioning ulnar nerve directly to the biceps branch of the musculocutaneous nerve to restore elbow flexion. Their original description consisted of a series of four patients and a cadaveric study of the branching pattern of the musculocutaneous nerve to the biceps muscle.…”

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confidence: 99%

Nerve transfers to the biceps and brachialis branches to improve elbow flexion strength after brachial plexus injuries

Tung¹,

Novak²,

Mackinnon³

2004

FOC

121

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Object In this study the authors evaluated the outcome in patients with brachial plexus injuries who underwent nerve transfers to the biceps and the brachialis branches of the musculocutaneous nerve. Methods The charts of eight patients who underwent an ulnar nerve fascicle transfer to the biceps branch of the musculocutaneous nerve and a separate transfer to the brachialis branch were retrospectively reviewed. Outcome was assessed using the Medical Research Council (MRC) grade to classify elbow flexion strength in conjunction with electromyography (EMG). The mean patient age was 26.4 years (range 16–45 years) and the mean time from injury to surgery was 3.8 months (range 2.5–7.5 months). Recovery of elbow flexion was MRC Grade 4 in five patients, and Grade 4+in three. Reinnervation of both the biceps and brachialis muscles was confirmed on EMG studies. Ulnar nerve function was not downgraded in any patient. Conclusions The use of nerve transfers to reinnervate the biceps and brachialis muscle provides excellent elbow flexion strength in patients with brachial plexus nerve injuries.

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“…These studies comprise only 75 patients overall. 1,5,7,9,10,21,25 The differing results are shown in Table 5. Results of a metaanalysis 21 indicated that the accessory nerve-suprascapular nerve transfer is an effective repair technique; however, the indications for surgery in the various studies differed, and the results were not analyzed or presented uniformly.…”

Section: Nerve Transfermentioning

confidence: 98%

“…14,24 In adults who have undergone brachial plexus reconstruction, good results of shoulder function recovery have been reported. 1,4,7,10,21,22,24,28,34,35 Interpretation of the data presented, however, is difficult for the following reasons. First, the outcome data pertaining to different types and localizations of lesions have been pooled-for instance, superior trunk lesions have been grouped with axillary nerve lesions, and traction lesions with gunshot wounds and sharp wounds.…”

mentioning

confidence: 99%

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

Malessy¹,

Ruiter²,

Boer³

et al. 2004

FOC

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Object The aim of this retrospective study was to evaluate the restoration of shoulder function by means of supra-scapular nerve neurotization in adult patients with proximal C-5 and C-6 lesions due to a severe brachial plexus traction injury (BPTI). The primary goal of brachial plexus reconstructive surgery was to restore the biceps muscle function and, secondarily, to reanimate shoulder function. Methods Suprascapular nerve neurotization was performed by grafting the C-5 nerve in 24 patients and by accessory or hypoglossal nerve transfer in 29 patients. Additional neurotization involving the axillary nerve could be performed in 18 patients. Postoperative needle electromyography studies of the supraspinatus, infraspinatus, and deltoid muscles showed signs of reinnervation in most patients; however, active glenohumeral shoulder function recovery was poor. In nine (17%) of 53 patients supraspinatus muscle strength was Medical Research Council (MRC) Grade 3 or 4 and in four (8%) infraspinatus muscle power was Grade 3 or 4. In 18 patients in whom deltoid muscle reinnervation was attempted, MRC Grade 3 or 4 function was demonstrated in two (11%). In the overall group, eight patients (15%) exhibited glenohumeral abduction with a mean of 44 ± 17° (standard deviation [SD]) (median 45°) and four patients (8%) exhibited glenohumeral exorotation with a mean of 48 ± 24° (SD) (median 53°). In only three patients (6%) were both functions regained. Conclusions The reanimation of shoulder function in patients with proximal C-5 and C-6 BPTIs following supra-scapular nerve neurotization is disappointingly low.

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Neurotization via the Spinal Accessory Nerve in Complete Paralysis Due to Multiple Avulsion Injuries of the Brachial Plexus

Cited by 92 publications

References 0 publications

Early post operative results after repair of traumatic brachial plexus palsy

Early post operative results after repair of traumatic brachial plexus palsy

Nerve transfers to the biceps and brachialis branches to improve elbow flexion strength after brachial plexus injuries

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

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