DORSAL APPROACH TO TRANSFER THE DISTAL SPINAL ACCESSORY NERVE TO THE SUPRASCAPULAR NERVE FOR RESTORATION OF SHOULDER ABDUCTION, A PROMISING SURGERY IN THE TREATMENT OF BRACHIAL PLEXUS INJURIES: CASE REPORT

Abstract

Background: In the conventional anterior approach to transfer the spinal accessory nerve to the suprascapular nerve for stabilization and restoration of shoulder abduction often results in partial loss of trapezius muscle function. Dorsal approach as described initially by Guan SB and Bahm J in 2004 is expected to overcome some of these drawbacks of the anterior transfers. This approach preserved the function of upper trapezius muscle and the nerve transfer being closer to the target muscle produced an early reinnervation of the supraspinatus muscles.

Objectives: Application of dorsal approach to transfer the distal spinal accessory nerve to the suprascapular nerve for restoration of shoulder abduction in the treatment of brachial plexus injuries at the root level serves as the first assessment of the advantages and disadvantages of the method before wider deployment.

Methods: Case series report. Five patients with brachial plexus injuries at the root level lesions, did not recover with conservative treatment.

Results: The shortest follow-up period was 3.5 months and the longest was 14 months with supraspinatus muscle strength at M3-4; active range of motion of the shoulder abduction from 200 to 400, indicating recovery of the shoulder movement at 2.5 months (M2 muscle strength in particular) and always finding the suprascapular nerve, while there was one case of bleeding complications, though trapezius muscle strength was almost not affected, reaching M4-5 muscle strength.

Conclusions: Surgical transfer of the accessory nerve to the suprascapular nerve by the posterior approach promises to be an effective method in helping restore shoulder abduction function in patients with brachial plexus injury at the root level.

Keyword: dorsal approach, nerve transfer, spinal accessory nerve, suprascapular nerve, brachial plexus injuries