Effect of shorter nerve graft and selective motor branch of recipient nerve on nerve transfer surgery for elbow flexion in patients with brachial plexus injury
Issued Date
2023-11-01
Resource Type
eISSN
19330693
Scopus ID
2-s2.0-85176496927
Pubmed ID
36905656
Journal Title
Journal of neurosurgery
Volume
139
Issue
5
Start Page
1405
End Page
1411
Rights Holder(s)
SCOPUS
Bibliographic Citation
Journal of neurosurgery Vol.139 No.5 (2023) , 1405-1411
Suggested Citation
Pengked K., Laohaprasitiporn P., Monteerarat Y., Limthongthang R., Vathana T. Effect of shorter nerve graft and selective motor branch of recipient nerve on nerve transfer surgery for elbow flexion in patients with brachial plexus injury. Journal of neurosurgery Vol.139 No.5 (2023) , 1405-1411. 1411. doi:10.3171/2023.1.JNS222836 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/91152
Title
Effect of shorter nerve graft and selective motor branch of recipient nerve on nerve transfer surgery for elbow flexion in patients with brachial plexus injury
Author's Affiliation
Other Contributor(s)
Abstract
OBJECTIVE: The spinal accessory nerve (SAN) is commonly used as a donor nerve for reinnervation of elbow flexors in brachial plexus injury (BPI) reconstruction. However, no study has compared the postoperative outcomes between SAN-to-musculocutaneous nerve (MCN) transfer and SAN-to-nerve to biceps (NTB) transfer. Thus, this study aimed to compare the postoperative time to recovery of elbow flexors between the two groups. METHODS: A total of 748 patients who underwent surgical treatment for BPI between 1999 and 2017 were retrospectively reviewed. Among them, 233 patients were treated with nerve transfer for elbow flexion. Two techniques were used to harvest the recipient nerve: the standard dissection technique and the proximal dissection technique. The postoperative motor power of elbow flexion was assessed every month for 24 months using the Medical Research Council (MRC) grading system. Survival and Cox regression analyses were used to compare the time to recovery (MRC grade ≥ 3) between the two groups. RESULTS: Of the 233 patients who underwent nerve transfer surgery, there were 162 patients in the MCN group and 71 patients in the NTB group. At 24 months after surgery, the MCN group had a success rate of 74.1%, and the NTB group had a success rate of 81.7% (p = 0.208). When compared with the MCN group, the NTB group had a significantly shorter median time to recovery (19 months vs 21 months, p = 0.013). Only 11.1% of patients in the MCN group regained MRC grade 4 or 5 motor power 24 months after nerve transfer surgery compared with 39.4% patients in the NTB group (p < 0.001). Cox regression analysis showed that the SAN-to-NTB transfer in combination with the proximal dissection technique was the only significant factor affecting time to recovery (HR 2.33, 95% CI 1.46-3.72; p < 0.001). CONCLUSIONS: SAN-to-NTB transfer in combination with the proximal dissection technique is the preferred nerve transfer option for restoration of elbow flexion in traumatic pan-plexus palsy.