Outcomes of Shoulder Functions in Spinal Accessory to Suprascapular Nerve Transfer in Brachial Plexus Injury: A Comparison between Anterior and Posterior Approach

Sanjay Maurya; Gopi Renganathan; Venkatnarayanan R.; Rajiv Bharti

doi:10.1055/s-0041-1731255

Indian Journal of Plastic Surgery, Table of Contents

CC BY-NC-ND 4.0 · Indian J Plast Surg 2021; 54(02): 152-156
DOI: 10.1055/s-0041-1731255

Original Article

Outcomes of Shoulder Functions in Spinal Accessory to Suprascapular Nerve Transfer in Brachial Plexus Injury: A Comparison between Anterior and Posterior Approach

Sanjay Maurya

¹Department of Plastic Surgery, AFMC, Pune, Maharashtra, India

,

Gopi Renganathan

¹Department of Plastic Surgery, AFMC, Pune, Maharashtra, India

,

Venkatnarayanan R.

¹Department of Plastic Surgery, AFMC, Pune, Maharashtra, India

,

Rajiv Bharti

¹Department of Plastic Surgery, AFMC, Pune, Maharashtra, India

› Author Affiliations

Abstract

Background Restoration of shoulder functions is important in brachial plexus injury (BPI). The functional outcomes of spinal accessory nerve (SAN) to suprascapular nerve (SSN) transfer by the anterior supraclavicular approach and the posterior approach is a matter of debate. This article aims to compare the outcomes of the shoulder functions by the SAN to the SSN transfer using the two approaches.

Methods Retrospective data was collected in 34 patients who underwent SAN to SSN transfer from January 2016 to June 2018. Group A included 16 patients who underwent nerve transfers by anterior approach, and Group B included 18 patients who underwent nerve transfers by posterior approach. Functional outcomes were measured by grading the muscle power as per the British Medical Research Council (MRC) grading (graded as M) and the range of motions (ROM) of the shoulder at 6 months and 18 months.

Results Early recovery was seen in group B with 7 patients (39%) showing M1 abduction power at 6 months as compared with one patient (6%) in group A . This difference was statistically significant (p value = 0.04). At 18 months, 10 patients (62%) in group A had good recovery (MRC grade ≥3), while 13 patients (72%) in group B had a good recovery. This difference was not found to be statistically significant (Fisher exact test p value = 0.71) There was no statistical difference in the outcomes of ROM in shoulder abduction, external rotation, and motor power at 18 months of follow-up.

Conclusions Early recovery was observed in the posterior approach group at 6 months, however, there was no significant difference in the outcomes of shoulder functions in muscle power and ROM in the two groups at 18 months of follow-up.

Keywords

nerve transfer - brachial plexus injury - posterior approach - suprascapular nerve - spinal accessory nerve

Full Text

References

References
1 Bhatia A, Kulkarni A, Zancolli P. et al. The effect of age and the delay before surgery on the outcomes of intercostal nerve transfers to the musculocutaneous nerve: a retrospective study of 232 cases of posttraumatic total and near-total brachial plexus injuries. Indian J Plast Surg 2020; 53 (02) 260-265
2 Bhandari PS, Maurya S. Recent advances in the management of brachial plexus injuries. Indian J Plast Surg 2014; 47 (02) 191-198
3 Guan SB, Chen DS, Fang YS. et al. An anatomic study of the descending branch of the spinal accessory nerve transfer for the repair of suprascapular nerve to restore the abduction function of the shoulder through the dorsal approach. Chin J Hand Surg(Chin) 2004; 20: 55-57
4 Bhandari PS, Sadhotra LP, Bhargava P. et al. Surgical outcomes following nerve transfers in upper brachial plexus injuries. Indian J Plast Surg 2009; 42 (02) 150-160
5 Colbert SH, Mackinnon S. Posterior approach for double nerve transfer for restoration of shoulder function in upper brachial plexus palsy. Hand (N Y) 2006; 1 (02) 71-77
6 Bertelli JA, Ghizoni MF. Transfer of the accessory nerve to the suprascapular nerve in brachial plexus reconstruction. J Hand Surg Am 2007; 32 (07) 989-998
7 Merrell GA, Barrie KA, Katz DL, Wolfe SW. Results of nerve transfer techniques for restoration of shoulder and elbow function in the context of a meta-analysis of the English literature. J Hand Surg Am 2001; 26 (02) 303-314
8 Songcharoen P, Wongtrakul S, Spinner RJ. Brachial plexus injuries in the adult. nerve transfers: the Siriraj Hospital experience. Hand Clin 2005; 21 (01) 83-89
9 Terzis JK, Kostas I, Soucacos PN. Restoration of shoulder function with nerve transfers in traumatic brachial plexus palsy patients. Microsurgery 2006; 26 (04) 316-324
10 Leechavengvongs S, Malungpaishorpe K, Uerpairojkit C, Ng CY, Witoonchart K. Nerve transfers to restore shoulder functions. Hand Clin 2016; 32 (02) 153-164
11 Dailiana ZH, Mehdian H, Gilbert A. Surgical anatomy of spinal accessory nerve: is trapezius functional deficit inevitable after division of the nerve?. J Hand Surg [Br] 2001; 26 (02) 137-141
12 Ochiai N, Nagano A, Okinaga S, Murashima R, Tachibana S. Brachial plexus injuries: surgical treatment of combined injuries of the axillary and suprascapular nerves. J Jpn Soc Surg Hand 1988; 5: 151-155
13 Mikami Y, Nagano A, Ochiai N, Yamamoto S. Results of nerve grafting for injuries of the axillary and suprascapular nerves. J Bone Joint Surg Br 1997; 79 (04) 527-531
14 Pruksakorn D, Sananpanich K, Khunamornpong S, Phudhichareonrat S, Chalidapong P. Posterior approach technique for accessory-suprascapular nerve transfer: a cadaveric study of the anatomical landmarks and number of myelinated axons. Clin Anat 2007; 20 (02) 140-143
15 Bhandari PS, Deb P. Dorsal approach in transfer of the distal spinal accessory nerve into the suprascapular nerve: histomorphometric analysis and clinical results in 14 cases of upper brachial plexus injuries. J Hand Surg Am 2011; 36 (07) 1182-1190
16 Guan SB, Hou CL, Chen DS, Gu YD. Restoration of shoulder abduction by transfer of the spinal accessory nerve to suprascapular nerve through dorsal approach: a clinical study. Chin Med J (Engl) 2006; 119 (09) 707-712
17 Souza FH, Bernardino SN, Filho HC. et al. Comparison between the anterior and posterior approach for transfer of the spinal accessory nerve to the suprascapular nerve in late traumatic brachial plexus injuries. Acta Neurochir (Wien) 2014; 156 (12) 2345-2349
18 Rui J, Zhao X, Zhu Y, Gu Y, Lao J. Posterior approach for accessory-suprascapular nerve transfer: an electrophysiological outcomes study. J Hand Surg Eur Vol 2013; 38 (03) 242-247
19 Terzis JK, Kostas I. Suprascapular nerve reconstruction in 118 cases of adult posttraumatic brachial plexus. Plast Reconstr Surg 2006; 117 (02) 613-629
20 Chuang DC, Lee GW, Hashem F, Wei FC. Restoration of shoulder abduction by nerve transfer in avulsed brachial plexus injury: evaluation of 99 patients with various nerve transfers. Plast Reconstr Surg 1995; 96 (01) 122-128
21 Venkatramani H, Bhardwaj P, Faruquee SR, Sabapathy SR. Functional outcome of nerve transfer for restoration of shoulder and elbow function in upper brachial plexus injury. J Brachial Plex Peripher Nerve Inj 2008; 3: 15
22 Mohammadraza E, Alijani B, Andalib S. Long term clinical outcomes of spinal accessory nerve transfer to suprascapular nerve in patients with brachial plexus injury. Acta Neurochir (Wien) 2016; 158 (09) 1801-1806