Transfer of the supinator nerve to the posterior interosseous nerve for hand opening in tetraplegia through an anterior approach

Abstract

We report a retrospective series of 44 transfers in 26 patients in whom a functioning supinator nerve was transferred to a paralyzed posterior interosseous nerve through a single, anterior approach to re-animate hand opening in mid-cervical tetraplegia. Eighteen patients underwent concurrent nerve or tendon transfers to re-animate grasp and/or pinch through the same anterior incision. We evaluated the strength of the innervated muscle at mean follow-up of 24 months (range 12–27). The strength attained in our patients was equivalent to the strength after the transfer through a posterior approach reported in the literature. Nineteen of our patients were satisfied with the hand opening procedure. First webspace opening was the only variable to correlate with patient satisfaction. We conclude that the anterior approach yields similar results to the posterior approach and has the advantage of allowing easier access for simultaneously performing nerve or tendon transfers to reconstruct grasp and pinch. Level of evidence: IV

Volar versus dorsal approach for supinator to posterior interosseous nerve transfer: An anatomical study in cadavers

“…Of note, the volar exposure as described here and in prior studies (Arnaout et al, 2019;Li et al, 2016;van Zyl et al, 2021;Ziaziaris et al, 2022) requires dissection in closer proximity to additional neurovascular structures than the dorsal approach. However, if one follows the volar exposure technique as described, structures such as the median nerve, brachial artery, and brachial vein, are not encountered.…”

“…The supinator to posterior interosseous nerve (SPIN) transfer is a viable option for reconstruction of finger and thumb extension and thumb abduction, restoring the release phase of grasp in patients with low radial nerve palsy, C7-T1 brachial plexus injury, and C6 level tetraplegia (Bertelli et al, 2009;Bertelli & Ghizoni, 2010;van Zyl et al, 2014van Zyl et al, , 2019van Zyl et al, , 2021Xu et al, 2015). The present study is the first investigation assessing whether differences existed between dorsal and volar approach in supinator motor branch length measurements and the ability to achieve a tension-free end-to-end neurorrhaphy.…”

“…Since first described by Bertelli et al (2009), the supinator motor branch to posterior interosseous nerve (SPIN) transfer has been used by peripheral nerve surgeons for reconstruction of finger and thumb extension (van Zyl et al, 2014(van Zyl et al, , 2019(van Zyl et al, , 2021. Coined the "SPIN" transfer, this intraplexal transfer is feasible due to differing radial nerve myotomes, with supinator innervation primarily derived from C6, whereas the remainder of the PIN derives from C7 (Roberts & Oliveros, 1999;Zhang et al, 2012).…”

“…The proximal leading edge of pronator teres (PT) can just be seen (double white asterisk) for SPIN transfer, the dual forearm exposure adds operative time and dissection, intra-operative limb position changes, and repeat microscope maneuvering and setup. Performing SPIN transfer volarly may theoretically circumvent these challenges (Arnaout et al, 2019;van Zyl et al, 2021;Ziaziaris et al, 2022). No study has compared dorsal versus volar approach to perform the SPIN transfer.…”

A Prediction Model for Various Treatment Pathways of Upper Extremity in Tetraplegia

“…Depending upon the extent of voluntary motor function in the recipient's muscle, reconstructive nerve transfers such as SPIN (supinator donor nerve to recipient posterior interosseus nerve for finger extension) and AIN (brachial donor nerve to recipient anterior interosseus nerve for finger flexion) are also indicated ( 45 , 46 ). Notably, EDC with intact LMN and FDP with damaged LMN would contraindicate taping or splinting to reach a tenodesis.…”