A Modified Posterior Approach to the Nerve Transfer of the Spinal Accessory Nerve to the Suprascapular Nerve

Q3 Medicine
Lenny L. Rivera-Rosario MD , Ruben Tresgallo Parés MD , José I. Acosta-Julbe MD , Alexandra Claudio Marcano MD , Joseph Salem-Hernández BS , Gerardo S. Caussade Silvestrini BS , Norman Ramirez MD , Christian Foy-Parrilla MD
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引用次数: 0

Abstract

Purpose

Restoration of shoulder abduction and external rotation is critical in patients with upper brachial plexus injuries (BPIs). The transfer of the spinal accessory nerve to the suprascapular nerve is a well-established surgical technique; however, the optimal approach remains debated. The traditional posterior approach may compromise muscle integrity because of trapezius detachment and splitting of the supraspinatus. This study introduces a muscle-sparing modification to the posterior approach and evaluates functional outcomes in pediatric and adult patients with obstetric or traumatic BPIs.

Methods

A retrospective review was conducted on patients who underwent spinal accessory nerve to suprascapular nerve transfer using a muscle-sparing posterior approach from September 2018 to November 2022. Inclusion criteria comprised pediatric patients (aged ≤18 months) with obstetric BPIs and adult patients with traumatic BPIs with a minimum postoperative follow-up of 24 months. Pediatric patients were evaluated using the Toronto Muscle Grading System, Modified Mallet Grading System, and Birch Triple System. Adults were assessed using range of motion and Disabilities of the Arm, Shoulder, and Hand questionnaire scores.

Results

Fourteen patients met the inclusion criteria (six pediatric and eight adult). Pediatric outcomes demonstrated Modified Mallet Grading System scores of grade IV and Birch Triple System stages IV–V, indicating good shoulder function. Toronto Muscle Grading System scores of 3 reflected active movement against gravity. Among adults, mean forward flexion improved from 35° to 53°, abduction improved from 28° to 47°, and external rotation improved from 12° to 23°. The mean Disabilities of the Arm, Shoulder, and Hand questionnaire score improved from 91 to 48, exceeding the minimal clinically notable difference. No complications were observed.

Conclusions

The muscle-sparing posterior approach for spinal accessory nerve to suprascapular nerve transfer is a safe and effective technique that yields favorable functional outcomes in both pediatric and adult BPI populations. Further comparative studies are warranted.

Type of study/level of evidence

Therapeutic IV.
脊神经副神经至肩胛上神经转移的改良后入路
目的肩部外展和外旋的恢复是上臂神经丛损伤(BPIs)患者的关键。脊副神经到肩胛上神经的转移是一种成熟的手术技术;然而,最佳方法仍存在争议。由于斜方肌脱离和冈上肌分裂,传统的后入路可能会损害肌肉的完整性。本研究介绍了一种保留肌肉的后路手术方法,并评估了产科或创伤性bpi的儿童和成人患者的功能结局。方法回顾性分析2018年9月至2022年11月经保肌后路行脊副神经至肩胛上神经转移的患者。纳入标准包括产科bpi的儿科患者(年龄≤18个月)和创伤性bpi的成人患者,术后随访时间至少为24个月。使用多伦多肌肉分级系统、改良木槌分级系统和桦木三重分级系统对儿科患者进行评估。成人评估使用活动范围和残疾的手臂,肩膀和手问卷得分。结果14例患者符合纳入标准(儿童6例,成人8例)。儿童结局显示改良的Mallet分级系统评分为IV级,Birch三重系统评分为IV - v级,表明肩部功能良好。多伦多肌肉分级系统的3分反映了积极的运动对抗重力。在成人中,平均前屈从35°改善到53°,外展从28°改善到47°,外旋从12°改善到23°。手臂、肩膀和手的平均残疾问卷得分从91分提高到48分,超过了最小的临床显著差异。无并发症发生。结论保留肌肉后路脊副神经转肩胛上神经是一种安全有效的技术,在儿童和成人BPI人群中均能获得良好的功能预后。进一步的比较研究是必要的。研究类型/证据水平治疗性IV。
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来源期刊
CiteScore
1.10
自引率
0.00%
发文量
111
审稿时长
12 weeks
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