Recovery of upper extremity function following endoscopically assisted contralateral C7 transfer for obstetrical brachial plexus injury

Leblebicioğlu, Gürsel; Ayhan, Ç.; Fırat, Tüzün; Üzümcügil, Akın; Yörübulut, Mehmet; Doral, Mahmut Nedim

doi:10.1177/1753193416638999

Cited by 27 publications

(17 citation statements)

References 49 publications

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“…Time since injury is a critical prognostic factor with nerve injury repair (Leblebicioglu et al, 2016). In general, primary surgery is not indicated to restore deficient functions after the age of 1-year-old in patients with BPBI (Kozin, 2008).…”

Section: Discussionmentioning

confidence: 99%

Double nerve transfer for restoring external rotation of the glenohumeral joint after neonatal brachial plexus injury

Soldado

2020

Microsurgery

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Introduction The probability of spontaneous recovery of shoulder external rotation in neonatal brachial plexus injury (NBPI) is very low after the age of 18 months. We report the outcomes of double nerve transfers to restore active external rotation of the glenohumeral joint in children with NBPI after this age. Patients and methods Retrospective analysis of 20 children of mean age of 23.8 months with a mean follow‐up of 14.8 months. Inclusion criteria were: age > 18 months, full passive glenohumeral external rotation in abduction, and absence of severe joint deformity on MRI. The spinal accessory nerve was transferred to the infraspinatus motor branch and the long head of the triceps motor branch to the teres minor motor branch. Anterior shoulder release was associated when passive shoulder external rotation in adduction (pERADD) was <30° (n = 13, Group R vs. Group N‐no release n = 7). Active shoulder elevation and external rotation in abduction (aERABD) of the glenohumeral joint were evaluated pre‐ and postoperatively. Results All children except two in Group R, recovered aERABD 4–6 months after surgery. Mean postoperative aERABD was 70 ± 32.4 and 82.9 ± 11.1° and shoulder elevation gain was 24.6 ± 22.2 and 27.1 ± 29.2° for Group R and N, respectively, without statistically significant differences. Conclusions Late nerve transfers to external rotator muscles are effective in children with NBPI. This might be explained not only by muscle reinnervation, but also by the interruption of a previous co‐contraction or developmental apraxia. Level of evidence Therapeutic IV.

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Section: Discussionmentioning

confidence: 99%

Double nerve transfer for restoring external rotation of the glenohumeral joint after neonatal brachial plexus injury

Soldado

2020

Microsurgery

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“…In order to overcome this disadvantage of the anterior vertebral approach, the investigators first performed lateral cervical 7 nerve transposition via the posterior vertebral approach for the treatment of central upper limb plegia (Leblebicioglu et al., 2016). Since then, another 10 cases have been operated using this procedure.…”

Section: Discussionmentioning

confidence: 99%

Preliminary results of posterior contralateral cervical 7 nerve transposition in the treatment of upper limb plegia after a stroke

et al. 2020

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“…Given that physiological or latent ipsilateral motor connections may be limited in humans, a novel and alternative approach is to leverage the ipsilateral uninjured hemisphere at the peripheral nervous system level, using peripheral nerve transfer. In a relevant clinical application to stroke, patients with brachial plexus injury have been treated surgically with nerve transfers, specifically C7 nerve root transfer, for several decades to help improve function and reduce spasticity in the affected limb [ 11 , 12 , 13 , 14 ]. The C7 nerve root is an ideal donor in these cases given that, among the C5-T1 nerve roots that form the brachial plexus, the C7 root comprises 20% of all fibers and its motor function overlaps with all four remaining roots [ 11 , 12 , 13 , 14 , 15 ].…”

Section: Leveraging the Contralesional Hemisphere In Motor Recovery After Strokementioning

confidence: 99%

“…In a relevant clinical application to stroke, patients with brachial plexus injury have been treated surgically with nerve transfers, specifically C7 nerve root transfer, for several decades to help improve function and reduce spasticity in the affected limb [ 11 , 12 , 13 , 14 ]. The C7 nerve root is an ideal donor in these cases given that, among the C5-T1 nerve roots that form the brachial plexus, the C7 root comprises 20% of all fibers and its motor function overlaps with all four remaining roots [ 11 , 12 , 13 , 14 , 15 ]. Therefore, following a C7 nerve transection or transfer, the donor arm will show transient weakness and sensory losses that tend to recover spontaneously.…”

Section: Leveraging the Contralesional Hemisphere In Motor Recovery After Strokementioning

confidence: 99%

“…The procedure for C7 nerve root transfer has been extensively described in the peripheral nerve surgery literature for the treatment of brachial plexus injury [ 11 , 12 , 13 , 14 , 15 , 16 ]. In the absence of data from randomized clinical trials on contralateral C7 nerve root transfer, evidence supporting improved hand function after transfer is limited to small sample size pilot studies and case series with a wide range of variability in surgical approaches.…”

Section: Contralateral C7 Nerve Root Transfer Techniquementioning

confidence: 99%

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Contralateral C7 Nerve Transfer for Stroke Recovery: New Frontier for Peripheral Nerve Surgery

Alawieh

Yong

Boulis

2021

JCM

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Ischemic stroke remains a major cause of disability in the United States and worldwide. Following the large-scale implementation of stroke thrombectomy and the optimization of treatment protocols for acute stroke, the reduction in stroke-associated mortality has resulted in an increased proportion of stroke survivors, many of whom have moderate to severe disability. To date, the treatment of subacute and chronic stroke has remained a challenge. Several approaches, involving pharmacological interventions to promote neuroplasticity, brain stimulation strategies and rehabilitative interventions, are currently being explored at different stages of the translational spectrum, yet level 1 evidence is still limited. In a recent landmark study, surgical intervention using contralateral C7 nerve transfer, an approach used to treat brachial plexus injury, was implemented in patients with chronic stroke, demonstrating an added benefit to standard rehabilitation strategies, leading to improved motor performance and reduced spasticity. The procedure involved the transfer of the C7 nerve root and middle trunk from the uninjured extremity to the injured extremity using a short conduit that allows for faster regeneration and innervation of the injured upper extremity via the ipsilateral (contralesional) hemisphere. In this work, we review the rationale for using contralateral C7 nerve transfer in stroke, describe the surgical intervention with associated variations and limitations, and discuss the current evidence for the efficacy of this technique in ischemic stroke research.

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Recovery of upper extremity function following endoscopically assisted contralateral C7 transfer for obstetrical brachial plexus injury

Abstract: Level IV.

Cited by 27 publications

References 49 publications

Double nerve transfer for restoring external rotation of the glenohumeral joint after neonatal brachial plexus injury

Double nerve transfer for restoring external rotation of the glenohumeral joint after neonatal brachial plexus injury

Preliminary results of posterior contralateral cervical 7 nerve transposition in the treatment of upper limb plegia after a stroke

Contralateral C7 Nerve Transfer for Stroke Recovery: New Frontier for Peripheral Nerve Surgery

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