Suprascapular nerve neurotization in obstetrical brachial plexus palsy using the spinal accessory nerve or the C5 root

Abstract

ObjectiveTo evaluate the value of distal spinal accessory nerve (SAN) or 5th cervical (C5) root neurotization to the suprascapular nerve (SSN) in infants with obstetrical brachial plexus birth palsy.BackgroundSurgical treatment of obstetrical brachial plexus birth palsy in infants includes neurolysis, nerve repair directly, or the use of interposition nerve graft and neurotization procedures. Repair of SSN is the key to restoration of shoulder joint function.Materials and methodsOver a 3-year period, 30 infants with brachial plexus injuries were subjected to SSN repair, 18 infants by neurotization to the SAN and 12 infants by interposition nerve grafting to the C5 root as part of the primary surgical reconstruction. Operative and postoperative outcomes were evaluated with a minimum follow-up of 18 months.ResultsNeurotization of the SSN was performed by intraplexal neurotization using a nerve graft to C5 in 12 patients (40%) or extraplexal neurotization using SAN directly in 18 patients (60%). Nineteen infants were subjected to surgical reconstruction at less than 6 months of age and 11 were subjected to surgical reconstruction, age range 3 to 16 months, mean 5 months. At the latest follow-up, active shoulder movements were measured confirmed by review of videos. The outcome of nerve injury was assessed using the peripheral nerve injury unit scale. The results of neurotization and the use of an interpositional nerve graft were analyzed. SSN neurotization outcome by SAN showed 94.4% good outcome and 5.6% fair outcome, which were better than outcome by C5 root neurotization (66.7% good and 33.3% fair). Five patients developed a postoperative superficial wound infection.ConclusionAlthough both SAN and C5 root neurotization to the SSN nerve are reliable options for shoulder reinnervation in infants with obstetrical brachial plexus palsy, direct neurotization without an interpositional nerve graft yields better results.