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Comparison of Spinal Accessory Nerve Transfer versus C5 Grafting for Suprascapular Nerve Reinnervation in Brachial
Maria Hyttinen1, Henrikki Rönkkö2, Pasi Paavilainen3
1From the Faculty of Medicine and Health Technology, Tampere University.
Background:
Nerve roots of the upper trunk are usually affected in brachial plexus birth injury. The suprascapular nerve originates from the upper trunk and innervates the infraspinatus muscle, which is the most important external rotator of the shoulder. Two common options for reinnervating the suprascapular nerve are from C5 with an interposition nerve graft or directly from the spinal accessory nerve. The aim of this study was to compare improvement in shoulder external rotation after brachial plexus reconstruction in patients with suprascapular nerve grafted from C5 or with spinal accessory nerve transfer.
Methods:
The authors retrospectively evaluated improvement of shoulder function in 16 patients after brachial plexus grafting with suprascapular nerve grafted from C5 and in 15 patients with concurrent spinal accessory nerve to suprascapular nerve transfer. In addition, results of secondary suprascapular nerve reinnervations with the spinal accessory nerve after failed nerve grafting ( n = 7) were compared with the procedure performed at the primary surgery.
Results:
Mean improvement in external rotation was better in the nerve transfer group (mean 94 degrees [SD 61]) compared with the nerve graft group (mean 44 degrees [SD 54]; P = 0.023). The nerve graft group had an increased risk of secondary operations to improve active external rotation ( P = 0.002), but not for anterior release procedures ( P = 0.419). The outcome of spinal accessory nerve transfer was not diminished after primary grafting of the suprascapular nerve from C5 (mean 90 degrees [SD 37]; P = 0.875).
Conclusion:
Spinal accessory nerve transfer results in better active shoulder external rotation when compared with grafting of the suprascapular nerve from C5 and reduces the risk of secondary surgery.
