Contralateral Spinal Accessory Nerve Transfer: A New Technique in Panavulsive Brachial Plexus Palsy

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Reconstructive Surgery

Background:

• Brachial plexus avulsion, often from motor vehicle accidents, causes severe limb dysfunction.
• Panavulsive brachial plexus palsy presents a significant reconstructive challenge, especially when donor nerves are limited.

Purpose of the Study:

• To describe an alternative surgical technique for brachial plexus avulsion repair.
• To evaluate the efficacy of transferring the contralateral spinal accessory nerve to the suprascapular nerve for shoulder function restoration.

Main Methods:

• A 28-year-old male with panavulsive brachial plexus palsy underwent contralateral spinal accessory nerve transfer to the suprascapular nerve.
• Clinical and electromyographic assessments were performed postoperatively.

Main Results:

• Positive clinical and electromyographic outcomes were observed in multiple muscle groups, including the sternocleidomastoid, trapezius, supraspinatus, infraspinatus, pectoralis, triceps, and biceps.
• Good shoulder function and stability were achieved at 12 months post-surgery.

Conclusions:

• Contralateral spinal accessory nerve transfer is a viable technique for severe brachial plexus injuries.
• This method offers a unique solution for shoulder stability and mobility preservation without bone fusion, even with limited donor nerves.