Restoration of elbow flexion in brachial plexus avulsion injury: Comparing spinal accessory nerve transfer with intercostal nerve transfer

Abstract

This study was performed to compare the clinical outcome of 2 types of commonly used nerve transfers, the spinal accessory nerve transfer and the intercostal nerve transfer. This study was a prospective randomized parallel trial involving 205 patients presenting between 1989 and 1994. All patients were males ranging in age from 16 to 43 years. All patients underwent surgery within 6 months of injury. Spinal accessory nerve transfer was performed in 130 patients; better results were obtained in terms of less operative time, fewer blood transfusions, fewer immediate complications, and better motor function (very good and good power in 83% of patients). Intercostal nerve transfer was performed in 75 patients; better results were observed in terms of earlier electromyographic evidence of motor reinnervation, improvement in protective sensation, and reduction of pain. However, very good and good motor recovery was observed in only 64% of patients. There was no significant difference with regard to tidal volume, vital capacity, and the FEV1to FEV ratio before and after surgery in either group. Smoking adversely affected the rate of recovery. Spinal accessory nerve transfer should be used when motor function of the elbow flexors is the major concern. Intercostal nerve transfer should be performed in patients who need both motor and sensory reconstruction and in those who have chronic pain syndrome after brachial plexus injury.