Iatrogenic Cervical Nerve Root Injury After Spine Surgery: How Nerve Surgeons Can Assist Spine Surgeons

Abstract

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.

Surgical Management of Iatrogenic Nerve Root Palsy: Cervical Root

“…Although aforementioned data could help neurosurgeons to limit the risk of iatrogenic nerve palsy, nothing could diminish the risk of injury completely. 1…”

“…ICN, SAN, and medial pectoral nerves are other possible donors to reinnervation of the MCN (Table 2). 1,7…”

“…In our experience, transferring a fascicle of the ulnar nerve to the long head of the triceps branches of the radial nerve is preferable to restore elbow extension (Figure 3). 1,4,5,9 Hand Function C7-T1 or C8-T1 nerve root injury is rarely seen as a complication of cervical spine surgery. However, theoretically, the anterior interosseous nerve (AIN) and the posterior interosseous nerve (PIN) are principal target nerves for restoring finger flexion and extension, respectively.…”

“…To reanimation of finger extension (reinnervation of the PIN), the nerve to the flexor carpi radialis, which originates from the median nerve (C6-C7), is preferable. 1,8…”

Surgical Management of Iatrogenic Nerve Root Palsy: Cervical Root

“…An end-toend coaptation repair is performed using 9-0 nylon epineural sutures evenly spaced about the circumference of nerves and reinforced with fibrin glue. 1,4,5…”