Comparison between the anterior and posterior approach for transfer of the spinal accessory nerve to the suprascapular nerve in late traumatic brachial plexus injuries

Souza, Fernando Henrique Morais de; Bernardino, Silvya Nery; Filho, Henrique Crósio; Gobbato, Pedro Luís; Martins, Roberto S.; Martins, Hugo A. L.; Silva‐Néto, Raimundo Pereira

doi:10.1007/s00701-014-2222-6

Cited by 28 publications

(19 citation statements)

References 13 publications

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“…In this study, we have found SAN to SSN transfer to provide only modest improvement when evaluating all injury types. Forty‐one percent of patients achieved some degree of ER in the current study, which is comparable to other reports in patient samples with heterogenous brachial plexus injuries . Yet, only 33% of these patients achieved ER within a useful range of motion needed for activities of daily living, which is more likely the true marker of a successful outcome.…”

Section: Discussionsupporting

confidence: 83%

“…In the pediatric BPI literature, restoration of ER is emphasized, while adult BPI reviews have reported primarily shoulder abduction data . Reports of infraspinatus function following the SAN to SSN nerve transfer are highly variable and often contradicting, ranging from 8% to 100% in UT injuries . The purpose of this study is to critically evaluate recovery of ER following the SAN transfer to the SSN and to determine the factors affecting outcomes.…”

mentioning

confidence: 99%

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Evaluation of infraspinatus reinnervation and function following spinal accessory nerve to suprascapular nerve transfer in adult traumatic brachial plexus injuries

et al. 2016

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Although 85% had EMG signs of recovery, the SAN to SSN transfer failed to provide useful recovery of ER through reinnervation of the infraspinatus muscle in injuries involving more levels than a C5-C6 root/upper trunk pattern. In patients with greater than C5-6 level injuries alternatives to SAN to SSN transfer should be considered to restore shoulder ER. © 2016 Wiley Periodicals, Inc. Microsurgery 37:365-370, 2017.

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Section: Discussionsupporting

confidence: 83%

mentioning

confidence: 99%

Evaluation of infraspinatus reinnervation and function following spinal accessory nerve to suprascapular nerve transfer in adult traumatic brachial plexus injuries

et al. 2016

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“…These patients made up 75% of all patients who did not reach functional recovery. 22 In the patient group reported by Souza et al 79 no one was operated on before 6 months, all due to late referrals. Dubuisson even reported an average referral time of 6.8 months after injury.…”

Section: Late Referralsmentioning

confidence: 98%

“…Among the studies that reported individual patientlevel data, timing of operation and motor outcome were collected. 5,6,20,24,35,[48][49][50]52,56,[61][62][63][64]66,74,76,77,79,80,82,90,[93][94][95] A total of 569 patients were described individually. Patients were categorized into 5 groups based on length of delay (0-3, 3-6, 6-9, 9-12, and > 12 months; Table 4): 27.4% of patients were operated on within 3 months and 65.5% of all patients were operated on within 6 months.…”

Section: Individual-level Patient Datamentioning

confidence: 99%

“…A recurring barrier to optimal treatment for these pa-tients is a delay in referral. 1,22,24,28,38,45,54,70,79 Dolan et al 22 reported that late referral was the reason for delayed surgery in every one of their patients operated on at least 6 months after the injury. These patients made up 75% of all patients who did not reach functional recovery.…”

Section: Late Referralsmentioning

confidence: 99%

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Timing of surgery in traumatic brachial plexus injury: a systematic review

Martin

Senders

DiRisio

et al. 2019

Journal of Neurosurgery

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OBJECTIVE Ideal timeframes for operating on traumatic stretch and blunt brachial plexus injuries remain a topic of debate. Whereas on the one hand spontaneous recovery might occur, on the other hand, long delays are believed to result in poorer functional outcomes. The goal of this review is to assess the optimal timeframe for surgical intervention for traumatic brachial plexus injuries. METHODS A systematic search was performed in January 2017 in PubMed and Embase databases according to the PRISMA guidelines. Search terms related to "brachial plexus injury" and "timing" were used. Obstetric plexus palsies were excluded. Qualitative synthesis was performed on all studies. Timing of operation and motor outcome were collected from individual patient data. Patients were categorized into 5 delay groups (0-3, 3-6, 6-9, 9-12, and > 12 months). Median delays were calculated for Medical Research Council (MRC) muscle grade ≥ 3 and ≥ 4 recoveries. RESULTS Forty-three studies were included after full-text screening. Most articles showed significantly better motor outcome with delays to surgery less than 6 months, with some studies specifying even shorter delays. Pain and quality of life scores were also significantly better with shorter delays. Nerve reconstructions performed after long time intervals, even more than 12 months, can still be useful. All papers reporting individual-level patient data described a combined total of 569 patients; 65.5% of all patients underwent operations within 6 months and 27.4% within 3 months. The highest percentage of ≥ MRC grade 3 (89.7%) was observed in the group operated on within 3 months. These percentages decreased with longer delays, with only 35.7% ≥ MRC grade 3 with delays > 12 months. A median delay of 4 months (IQR 3-6 months) was observed for a recovery of ≥ MRC grade 3, compared with a median delay of 7 months (IQR 5-11 months) for ≤ MRC grade 3 recovery. CONCLUSIONS The results of this systematic review show that in stretch and blunt injury of the brachial plexus, the optimal time to surgery is shorter than 6 months. In general, a 3-month delay appears to be appropriate because while recovery is better in those operated on earlier, this must be considered given the potential for spontaneous recovery.

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Functional and morphological evaluation of the trapezius muscle after spinal accessory nerve transfer to brachial plexus nerves

Simão,

Heise,

Rodrigues

et al. 2024

Microsurgery

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IntroductionThe main innervation of the trapezius muscle is provided by the spinal accessory nerve. Several studies describe the contributions of cervical plexus roots to the trapezius muscle innervation, either directly or through connections with the spinal accessory nerve. There is no adequate understanding of how the trapezius muscle is affected after using the spinal accessory nerve in nerve transfer procedures with the usual technique, preserving at least 1 branch for the upper trapezius.MethodsWe evaluated 20 patients with sequelae of traumatic brachial plexus injury who underwent surgical procedures for brachial plexus repair or free muscle transfer, which included the spinal accessory nerve transfer technique and were followed for a minimum of 1 year. The three portions trapezius muscle were evaluated by physical examination, magnetic resonance imaging (analysis of fatty degeneration) and electromyography.ResultsIn all evaluation methods, the middle and lower portions of the trapezius muscle showed more significant morphological and/or functional impairment than the upper portion, in most cases. There was a statistically significant difference in all the complementary exams results, between the affected side (with sacrifice of the nerve) versus the normal side, in the middle and lower portions of the trapezius muscle.ConclusionsPhysical examination alone is not sufficient to determine the residual functionality of the trapezius muscle. Magnetic resonance imaging and electromyography are useful tools to assess both morphological involvement of the trapezius muscle and nerve conduction impairment of the trapezius muscle, respectively. The results suggest that the middle and lower portions of the trapezius muscle are affected by previous SAN transfer and should be considered with caution for further muscle transfer procedures.

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Comparison between the anterior and posterior approach for transfer of the spinal accessory nerve to the suprascapular nerve in late traumatic brachial plexus injuries

Abstract: Better results in terms of external arm rotation were obtained when spinal accessory-to-suprascapular nerve transfer was performed using the posterior approach.

Cited by 28 publications

References 13 publications

Evaluation of infraspinatus reinnervation and function following spinal accessory nerve to suprascapular nerve transfer in adult traumatic brachial plexus injuries

Evaluation of infraspinatus reinnervation and function following spinal accessory nerve to suprascapular nerve transfer in adult traumatic brachial plexus injuries

Timing of surgery in traumatic brachial plexus injury: a systematic review

Functional and morphological evaluation of the trapezius muscle after spinal accessory nerve transfer to brachial plexus nerves

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