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Updated: Mar 24, 2026
Structured Motor Rehabilitation After Selective Nerve Transfers
Published on: August 15, 2019
Recovery of upper extremity function following endoscopically assisted contralateral C7 transfer for obstetrical
G Leblebicioglu1, C Ayhan2, T Firat2
1Department of Orthopaedic Surgery and Traumatology, Hacettepe University, Ankara, Turkey gurselleblebicioglu@ttmail.com.
Insights
This study introduces an endoscopy-assisted contralateral C7 nerve transfer for infants with obstetrical brachial plexus injuries. The technique demonstrated satisfactory functional recovery in shoulder, elbow, and hand function.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Microsurgery
Background:
- Obstetrical brachial plexus injury (OBPI) can lead to significant functional deficits in infants.
- Contralateral C7 nerve transfer is a reconstructive option, but rarely reported, especially in infants.
- Endoscopic techniques offer potential advantages in minimally invasive surgery.
Purpose of the Study:
- To describe a novel endoscopy-assisted contralateral C7 nerve transfer technique for OBPI reconstruction in infants.
- To evaluate the functional outcomes of this surgical approach.
- To assess the safety and efficacy of the prevertebral (retroesophageal) route for nerve transfer.
Main Methods:
- A cohort of 20 infants with OBPI underwent endoscopy-assisted contralateral C7 nerve transfer via the prevertebral route.
- The contralateral C7 nerve was transferred to lower nerve roots, upper nerve roots, or both.
- Functional recovery was assessed using the Gilbert and Raimondi scales for motor function and the Narakas Sensory Grading System for hand sensation.
- Mean follow-up was 45 months.
Main Results:
- All patients with preoperative poor scores showed good or satisfactory shoulder and elbow function postoperatively.
- Nine patients with lower nerve root reconstruction achieved satisfactory hand function.
- Fifteen children attained a Narakas score of S3, indicating significant sensory recovery.
- The technique was deemed safe for contralateral C7 transfer to avulsed roots.
Conclusions:
- Endoscopy-assisted contralateral C7 nerve transfer via the prevertebral route is a viable and safe technique for severe OBPI in infants.
- This approach can lead to satisfactory functional recovery of the upper extremity.
- The minimally invasive nature of the endoscopic technique may offer benefits in pediatric nerve reconstruction.
Unlabelled:
Transfer of the contralateral C7 nerve for reconstruction of the brachial plexus in infants with obstetrical brachial plexus injury has rarely been reported. We developed a new endoscopy-assisted technique via the prevertebral (retroesophageal) route for the transfer of the contralateral C7 nerve in reconstruction of the brachial plexus. The reconstruction was performed in 20 infants (14 boys and six girls). Motor recovery was assessed using the Gilbert and Raimondi scales. The Narakas Sensory Grading System was used to evaluate hand sensation. The mean follow-up period was 45 months (SD 18.2). Of the 20 children, nine had contralateral C7 transfer to lower nerve roots, two had transfer to upper nerve roots and nine had transfer to both upper and lower roots. The postoperative shoulder and elbow functions were good or satisfactory according to the Gilbert classification in all children whose preoperative scores were poor. All patients with lower roots reconstruction (9) had satisfactory hand function. A total of 15 children had a Narakas score of S3. Our technique enables safe contralateral C7 transfer to the avulsed roots in severe obstetrical brachial plexus injury infants with a satisfactory functional recovery.
Level Of Evidence:
Level IV.
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