Background: Iatrogenic cervical nerve root injury may occur during cervical spine surgeries, which leads to upper limb palsy. The question of how a permanent iatrogenic upper limb palsy would be managed remains unclear. Recent developments of nerve transfer have led to a considerable interest in its applications. This study outlines a new reconstructive approach forupper limb palsy following cervical spine surgery using nerve transfer.Methods: In an attempt to reconstruct iatrogenic upper limb palsy, we performed nerve transfer in 4 patients with permanently lost functions. Medical Research Council Scale for Muscle Strength was used to assess muscle strength. Electromyography was performed to assess the reinnervation of the target muscles.Results: All patients underwent surgery between 7 and 12 months after primary injury. Spinal accessory nerve to suprascapular nerve transfer with or without transferring the long head of triceps branch of the radial nerve to anterior branch of the axillary nerve was used to reconstruct shoulder abduction in 2 patients. Double fascicular nerve transfer (a fascicle of the ulnar nerve to biceps branch and a fascicle of the median nerve to brachialis branch of the musculocutaneous nerve) was used to reconstruct elbow flexion in 3 patients. One patient had lost both his elbow flexion and shoulder abduction. After a mean of 10 months of follow-up, all patients improved to a muscle strength of M4 without donor deficit .Conclusion: In our view, these results represent an excellent initial step toward the treatment of iatrogenic nerve root injury after spine surgery.Level of Evidence: 4.

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Purpose High median nerve injury leads to absence of thumb opposition and irreversible thenar atrophy. Currently, distal nerve transfer is a new option for opponensplasty. The superiority of nerve transfer over traditional tendon transfer is that in nerve transfer, all thenar muscles may be reinnervated and so thumb functions are fully achieved while in tendon transfer, the goal is to reanimate the function of abductor pollicis brevis. This study aims to describe the results of opponensplasty using distal nerve transfer. Methods This article analyses the results of opponensplasty using transfer of abductor digiti minimi branch of the ulnar nerve to recurrent branch of the median nerve. Clinical outcomes were assessed by objective evaluation of abductor pollicis brevis (APB) strength, degree of thumb opposition, and thenar muscle bulk. APB strength and degree of thumb opposition measured by Medical Research Council (MRC) and Kapandji scoring systems, respectively. Results From 2016 to 2019 six patients of mean age of 29.5 years (five males and one female) with high median nerve injury were considered for opponensplasty using nerve transfer. Clinical improvement including regaining APB strength and thumb opposition was achieved in all patients. Moreover, recovery of thenar atrophy was observed in five patients. Conclusions In high median-nerve injury, early reconstructive intervention can prevent the thenar muscle atrophy and leads to prompt reinnervation and complete restoration of thenar function. Abductor digiti minimi branch of the ulnar nerve is a superior donor for this purpose.