Comparison of spinal accessory nerve transfer to supra-scapular nerve vs. shoulder arthrodesis in adults with brachial plexus injury.
BACKGROUND
Restoring shoulder mobility, stability, and strength is a key goal in patients with brachial plexus injuries. Shoulder arthrodesis is chiefly used as an adjunct to, or after failure of, initial direct nerve surgery. The objective of this study was to compare clinical and functional shoulder outcomes after direct nerve transfer vs. shoulder arthrodesis in adults with supra-clavicular brachial plexus injuries.


HYPOTHESIS
Shoulder arthrodesis, currently used as a salvage procedure in brachial palsy injuries, deserves to be viewed to a valid alternative to direct nerve transfer.


MATERIAL AND METHODS
A retrospective study was conducted in 58 patients with a follow-up of at least 2 years. Among them, 20 were managed by transfer of a spinal accessory nerve fascicle to the supra-scapular nerve and 38 by shoulder arthrodesis. Outcome measures were shoulder range-of-motion, isometric shoulder strength, and the Disabilities of the Arm, Shoulder, and Hand (DASH) score.


RESULTS
Mean age at surgery was 24 years and mean follow-up was 46 months (range, 24-156 months). Motion ranges of the shoulder were not significantly different between the two treatment groups. Data variance was significantly greater in the nerve transfer group than in the shoulder arthrodesis group for scapular antepulsion (p=0.0011), abduction (p<0.001), and external rotation (p=0.0066). Strength was significantly greater in the arthrodesis group in all directions of motion. The DASH scores showed no significant between-group differences.


CONCLUSIONS
The results of this study conflict with the widely help opinion that nerve transfer to the supra-scapularis nerve produces better clinical outcomes compared to shoulder arthrodesis. Nerve transfer was not better than shoulder arthrodesis in our patients. The data variance heterogeneity suggests poor predictability and reliability of nerve transfer, in contrast to the modest but predictable and uniform results of shoulder arthrodesis.


LEVEL OF EVIDENCE
IV, retrospective observational comparative study.
['Degeorge|Benjamin|B|', 'Lazerges|Cyril|C|', 'Chammas|Pierre Emmanuel|PE|', 'Coulet|Bertrand|B|', 'Lacombe|Fabien|F|', 'Chammas|Michel|M|']
D000055:Accessory Nerve D000293:Adolescent D000328:Adult D001174:Arthrodesis D001917:Brachial Plexus D005260:Female D005500:Follow-Up Studies D006801:Humans D008297:Male D008875:Middle Aged D016067:Nerve Transfer D059348:Peripheral Nerve Injuries D016059:Range of Motion, Articular D020127:Recovery of Function D015203:Reproducibility of Results D012189:Retrospective Studies D012785:Shoulder Joint D016896:Treatment Outcome D055815:Young Adult
Nerve transfer Shoulder arthrodesis Brachial plexus Neurotization Scapulohumeral arthrodesis Spinal nerve