Surgical Reconstruction for Upper-Extremity Paralysis Following Acute Flaccid Myelitis

Doi, Kazuteru; Sem, Sei Haw; Hattori, Yasunori; Sakamoto, Sotetsu; Hayashi, Kota; Red-Gallego, María Ángeles de la

doi:10.2106/jbjs.oa.19.00030

Cited by 13 publications

(32 citation statements)

References 18 publications

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“…Case series have shown generally positive outcomes from nerve transfers for restoration of elbow function in appropriately selected patients, with less positive outcomes for restoration of shoulder function. 21,22,85 Muscle or tendon transfer, or both, has been reported in a few cases, with generally positive outcomes for restoration of elbow or hand function. 21,85 Anecdotal reports indicate that lower limb nerve transfers, nerve transfer to the phrenic nerve, and diaphragmatic pacing have been undertaken in individual cases; 86 however, there are few published data regarding outcomes in these cases.…”

Section: Acute Managementmentioning

confidence: 99%

“…21,22,85 Muscle or tendon transfer, or both, has been reported in a few cases, with generally positive outcomes for restoration of elbow or hand function. 21,85 Anecdotal reports indicate that lower limb nerve transfers, nerve transfer to the phrenic nerve, and diaphragmatic pacing have been undertaken in individual cases; 86 however, there are few published data regarding outcomes in these cases.…”

Section: Acute Managementmentioning

confidence: 99%

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Acute flaccid myelitis: cause, diagnosis, and management

et al. 2021

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Acute flaccid myelitis (AFM) is a disabling, polio-like illness mainly affecting children. Outbreaks of AFM have occurred across multiple global regions since 2012, and the disease appears to be caused by non-polio enterovirus infection, posing a major public health challenge. The clinical presentation of flaccid and often profound muscle weakness (which can invoke respiratory failure and other critical complications) can mimic several other acute neurological illnesses. There is no single sensitive and specific test for AFM, and the diagnosis relies on identification of several important clinical, neuroimaging, and cerebrospinal fluid characteristics. Following the acute phase of AFM, patients typically have substantial residual disability and unique long-term rehabilitation needs. In this Review we describe the epidemiology, clinical features, course, and outcomes of AFM to help to guide diagnosis, management, and rehabilitation. Future research directions include further studies evaluating host and pathogen factors, including investigations into genetic, viral, and immunological features of affected patients, host-virus interactions, and investigations of targeted therapeutic approaches to improve the long-term outcomes in this population.

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Section: Acute Managementmentioning

confidence: 99%

Section: Acute Managementmentioning

confidence: 99%

Acute flaccid myelitis: cause, diagnosis, and management

et al. 2021

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“…Doi et al retrospectively evaluated eight pediatric patients with upper extremity paralysis in the setting of AFM (Table 1). 59 All demonstrated improvement in overall Mallet score, with four patients (50%) obtaining at least 90 degrees of shoulder abduction. All five patients who underwent reconstruction to restore elbow function had more than 140 degrees of motion, with a median Medical Research Council muscle strength grade of 3.…”

Section: Resultsmentioning

confidence: 89%

“…When multiple limbs are involved, weakness tends to be asymmetric. 18,23,36,52,58 Weakness of proximal extremity muscles tends to be greater than distal muscles, both at initial presentation 5,18,30,59,63,75 and at long-term follow-up. 4–7 Many patients also report cranial nerve involvement and neck/trunk weakness.…”

Section: Resultsmentioning

confidence: 99%

“…Nerve transfers are the most common surgical intervention in the management of AFM. Early literature suggests that these procedures are a promising option for patients with persistent deficits caused by AFM, 6,19,30,45,59,64,66–68 with patients showing improvements in strength, range of motion, and nerve conduction and recruitment after nerve transfers (Table 1). 6,19,30,45,59,64,66–68…”

Section: Resultsmentioning

confidence: 99%

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Acute Flaccid Myelitis: Review of Clinical Features, Diagnosis, and Management with Nerve Transfers

Kozlowski¹,

Linzey

Muhlestein

et al. 2022

Plastic &Amp; Reconstructive Surgery

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cute flaccid myelitis (AFM) is a polio-like illness in children that causes inflammation of the spinal cord gray matter. AFM is characterized by a viral prodrome that is followed by mild to severe weakness in one to four limbs that can be persistent even after conservative management. 1 Almost one-third of patients admitted to the hospital require intubation because of weakness of respiratory muscles or bulbar muscle weakness. 2 AFM was initially recognized after the first major outbreak in the United States in 2014.

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Selective nerve transfers to restore shoulder abduction and flexion in acute flaccid myelitis: A case report

Liu,

Massenburg,

Otten

et al. 2023

Microsurgery

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Acute flaccid myelitis (AFM) is a polio‐like condition predominantly affecting children that is characterized by acute‐onset, asymmetric flaccid paralysis, often preceded by a prodromal fever or viral illness. With prompt diagnosis and early surgical referral, nerve transfers may be performed to improve function. Highly selective nerve transfers are ideal to preserve existing functions while targeting specific deficits. In this report, we present a case of a double fascicular nerve transfer of median and ulnar nerve fascicles to the axillary nerve, combined with selective transfer of the spinal accessory nerve to the supraspinatus branch of the suprascapular nerve, performed for a 5‐year‐old girl who developed AFM after an upper respiratory infection. Six months after the onset of the patient's symptoms, the patient had continued weakness of shoulder flexion and abduction, atrophy of the deltoid, and supraspinatus muscles, though needle electromyography revealed a functioning infraspinatus muscle. The patient had no post‐operative complications and at 2 years of postoperative follow up achieved shoulder abduction and flexion Active Movement Scale scores of 7/7 compared to preoperative scores of 2/7, with no loss of function in the donor nerve domains. The patient showed active shoulder abduction against gravity to 90° from 30° preoperatively and shoulder flexion to 180° from 15° preoperatively. This case report shows that highly selective nerve transfers may preserve existing functions while targeting specific deficits. A double fascicular transfer from the median and ulnar nerves to axillary nerve may provide abundant axons for functional recovery.

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Surgical Reconstruction for Upper-Extremity Paralysis Following Acute Flaccid Myelitis

Cited by 13 publications

References 18 publications

Acute flaccid myelitis: cause, diagnosis, and management

Acute flaccid myelitis: cause, diagnosis, and management

Acute Flaccid Myelitis: Review of Clinical Features, Diagnosis, and Management with Nerve Transfers

Selective nerve transfers to restore shoulder abduction and flexion in acute flaccid myelitis: A case report

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