Surgical approach to the spinal accessory nerve for brachial plexus reconstruction

Hattori, Yasunori; Doi, Kazuteru; Toh, Shintaroh; Baliarsing, Amresh S.

doi:10.1053/jhsu.2001.28762

Cited by 34 publications

(32 citation statements)

References 8 publications

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“…18 After cutting the clavicular head of the sternomastoid and insertion of the scalenus anterior muscle medially, and the clavicular and part of the acromial insertion of the trapezius muscle laterally, 19,20 exploration of the brachial plexus proceeded as described elsewhere.…”

Section: Operative Techniquementioning

confidence: 99%

Repair of brachial plexus lesions by end-to-side side-to-side grafting neurorrhaphy: Experience based on 11 cases

Amr

Moharram

2005

Microsurgery

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Eleven brachial plexus lesions were repaired using end-to-side side-to-side grafting neurorrhaphy in root ruptures, in phrenic and spinal accessory nerve neurotizations, in contralateral C7 neurotization, and in neurotization using intact interplexus roots or cords. The main aim was to approximate donor and recipient nerves and promote regeneration through them. Another indication was to augment the recipient nerve, when it had been neurotized or grafted to donors of dubious integrity, when it was not completely denervated, when it had been neurotized to a nerve with a suboptimal number of fibers, when it had been neurotized to distant donors delaying its regeneration, and when it had been neurotized to a donor supplying many recipients. In interplexus neurotization, the main indication was to preserve the integrity of the interplexus donors, as they were not sacrificeable. The principles of end-to-side neurorrhaphy were followed. The epineurium was removed. Axonal sprouting was induced by longitudinally slitting and partially transecting the donor and recipient nerves, by increasing the contact area between both of them and the nerve grafts, and by embedding the grafts into the split predegenerated injured nerve segments. Agonistic donors were used for root ruptures and for phrenic and spinal accessory neurotization, but not for contralateral C7 or interplexus neurotization. Single-donor single-recipient neurotization was successfully followed in phrenic neurotization of the suprascapular (3 cases) and axillary (1 case) nerves, spinal accessory neurotization of the suprascapular nerve (1 case), and dorsal part of contralateral C7 neurotization of the axillary nerve (2 cases). Apart from this, recipient augmentation necessitated many donor to single-recipient neurotizations. This was successfully performed using phrenic-interplexus root to suprascapular transfers (2 cases), phrenic-contralateral C7 to suprascapular transfer (1 case), and spinal accessory-interplexus root to musculocutaneous transfer (1 case). Both recipient augmentation and increasing the contact area between grafts and recipients necessitated single or multiple donor to many recipient neurotizations. This was applied in root ruptures (3 cases), with results comparable to those obtained in classical nerve-grafting techniques. It was also applied in ventral C7 transfer to the lateral or medial cords (3 cases) with functional recovery occurring in the biceps and pronator teres muscles, but not in dorsal C7 transfer to the axillary and radial nerves (3 cases) with functional recovery occurring in the deltoid and triceps muscles, and in whole C7 transfer to C5, 6, 7, 8T1 roots with functional recovery occurring in the deltoid (M4), biceps (M4), pronator teres (M4), and triceps (M3) (3 cases), and less so in the flexor carpi ulnaris and FDP (M3) (1 case) and the extensor digitorum longus (M3) (1 case). Contralateral C7 transfer to the lateral and posterior cords (4 cases) was followed by cocontractions that took 1 year to improve and that involved the...

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Section: Operative Techniquementioning

confidence: 99%

Repair of brachial plexus lesions by end-to-side side-to-side grafting neurorrhaphy: Experience based on 11 cases

Amr

Moharram

2005

Microsurgery

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“…Su ventaja es que se localiza al nEa distal a las ramas que inervan el trapecio superior. 21,26 En el 50% de los adultos, se produce una doble lesión del nS, sobre todo si existe fractura de la escápula, se recomienda una completa exploración para evitar un fracaso en la neurotización. 27 En la POPB, no se justifica este gesto, debido al diferente mecanismo de lesión, uno suele ser un traumatismo con estiramiento progresivo y el otro, un traumatismo agudo de alta energía.…”

Section: Discussionunclassified

Parálisis obstétrica del plexo braquial: resultados preliminares de la transferencia del nervio espinal accesorio al nervio supraescapular en 10 casos. [Accessory nerve to suprascapular nerve transfer in obstetrical brachial plexus palsy: preliminary results in 10 cases.]

Valbuena¹

2015

Rev. Asoc. Arg. Ort. y Traumatol

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113 ResumenObjetivo: Evaluar los resultados preliminares en 10 casos de transferencias del nervio espinal accesorio al nervio supraescapular en parálisis obstétricas del plexo braquial. Materiales y Métodos: Entre 2010 y 2012, se realizaron 16 transferencias del nervio espinal accesorio al nervio supraescapular en parálisis obstétricas del plexo braquial. Se incluyeron 10 casos con un seguimiento mínimo de 18 meses. Se evaluó la fuerza muscular del hombro según la escala de Gilbert y se usaron escalas funcionales de Mallet y de Gilbert. Se compararon valores preoperatorios y posoperatorios, así como las diferencias entre parálisis de tipo parcial y total. Se usó la prueba de Student para valorar la significancia estadística de los datos. Resultados: El seguimiento promedio fue de 20.9 meses. Se hallaron valores medios preoperatorios de fuerza de abducción de 0,48 M, y posoperatorios de 2,70 M; los valores de rotación externa preoperatorios fueron de 0 M y, al final del seguimiento, de 2,4 M. Todos los pacientes mostraban patrones preoperatorios de tipo 1 tanto de la escala de Mallet como la de Gilbert, con valores posoperatorios promedio de 3,2 y 3,5, respectivamente. Se hallaron diferencias estadísticamente significativas entre estos valores. Conclusiones: Esta serie presenta valores preliminares con un seguimiento corto y su principal crítica es el bajo número de casos. Los resultados funcionales obtenidos coinciden con los de otros reportes, y avalan su uso en las reconstrucciones del plexo braquial que requieran aporte extraplexual. were assessed according to the Gilbert scale, and functional scales of the shoulder (Mallet and Gilbert) were used. Preoperative and postoperative values, and the differences between partial and total paralysis results were compared. Student test was used for the statistical analysis. Results:The average follow-up was 20.9 months. Preoperative shoulder abduction power was 0.48 M, preoperative external rotation power was 0 M, and those values at the end of the follow-up were 2.70 M and 2.4 M, respectively. All patients had type 1 patterns of the Gilbert and Mallet scales, with mean postoperative values of 3.2 and 3.5, respectively. Statistically significant differences were found between these values. Conclusions: Limitations of this preliminary report are the short follow-up and the low number of cases. However, the functional results obtained are consistent with those from other reports, and they support the use of the spinal accessory nerve to suprascapular nerve transfer in brachial plexus reconstructions requiring an extra-plexual contribution.

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“…Following the description of Kawabata and colleagues [9] of the use of the spinal accessory nerve as an ipsilateral nerve transfer to the suprascapular nerve in infants with upper brachial plexus birth injuries, its use has continued to expand. Total the scores for active abduction/forward flexion and active external rotation; from [7] a Maximum shoulder score=10; decrease score by 1 point for a contracture >20°T Several groups [1,6,8,11,14,19,20] have published variable experiences with the use of the distal SAN-to-SSN transfer as part of a primary or secondary plexus reconstruction in infants who fail to demonstrate spontaneous recovery of active shoulder external rotation following a period of observation. In a retrospective review of 86 infants, Pondaag et al [14] found similar clinical results and functional scores in infants undergoing C5-to-SSN bypass grafting (n=65) and those who received direct SANto-SSN (n=21) transfers performed at a mean of 5 months of age.…”

Section: Discussionmentioning

confidence: 99%

Outcome Following Spinal Accessory to Suprascapular (Spinoscapular) Nerve Transfer in Infants with Brachial Plexus Birth Injuries

Ruchelsman

Ramos

Alfonso

et al. 2009

Hand (New York, N,Y.)

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The purpose of this study is to evaluate the value of distal spinal accessory nerve (SAN) transfer to the suprascapular nerve (SSN) in children with brachial plexus birth injuries in order to better define the application and outcome of this transfer in these infants. Over a 3-year period, 34 infants with brachial plexus injuries underwent transfer of the SAN to the SSN as part of the primary surgical reconstruction. Twenty-five patients (direct repair, n=20; interposition graft, n=5) achieved a minimum follow-up of 24 months. Fourteen children underwent plexus reconstruction with SAN-to-SSN transfer at less than 9 months of age, and 11 underwent surgical reconstruction at the age of 9 months or older. Mean age at the time of nerve transfer was 11.6 months (range, 5-30 months). At latest follow-up, active shoulder external rotation was measured in the arm abducted position and confirmed by review of videos. The Gilbert and Miami shoulder classification scores were utilized to report shoulder-specific functional outcomes. The effects of patient age at the time of nerve transfer and the use of interpositional nerve graft were analyzed. Overall mean active external rotation measured 69.6°; mean Gilbert score was 4.1 and the mean Miami score was 7.1, corresponding to overall good shoulder functional outcomes. Similar clinical and shoulder-specific functional outcomes were obtained in patients undergoing early (<9 months of age, n=14) and late (>9 months of age, n=11) SAN-to-SSN transfer and primary plexus reconstruction. Nine patients (27%) were lost to follow-up and are not included in the analysis. Optimum results were achieved following direct transfer (n=20). Results following the use of an interpositional graft (n=5) were rated satisfactory. No patient required a secondary shoulder procedure during the study period. There were no postoperative complications. Distal SAN-to-SSN (spinoscapular) nerve transfer is a reliable option for shoulder reinnervation in infants with brachial plexus birth injuries. Direct transfer seems to be the optimum method. The age of the patient does not seem to significantly impact on outcome.

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Surgical approach to the spinal accessory nerve for brachial plexus reconstruction

Cited by 34 publications

References 8 publications

Repair of brachial plexus lesions by end-to-side side-to-side grafting neurorrhaphy: Experience based on 11 cases

Repair of brachial plexus lesions by end-to-side side-to-side grafting neurorrhaphy: Experience based on 11 cases

Parálisis obstétrica del plexo braquial: resultados preliminares de la transferencia del nervio espinal accesorio al nervio supraescapular en 10 casos. [Accessory nerve to suprascapular nerve transfer in obstetrical brachial plexus palsy: preliminary results in 10 cases.]

Outcome Following Spinal Accessory to Suprascapular (Spinoscapular) Nerve Transfer in Infants with Brachial Plexus Birth Injuries

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