Spinal accessory to supra scapular nerve transfer: anterior vs posterior approach. A series of cases and review.

Abstract

Summary:

Background and objectives: in more than 90% of traumatic injuries of the brachial plexus, an affectation of the motility and stability of the shoulder is observed. Therefore, a high number of patients will require some type of surgery to stabilize the shoulder and recover abduction and external rotation. The objectives of this work are: 1) to compare the results of neurotization of the suprascapular nerve with fascicles of the spinal accessory nerve, by anterior and posterior approaches, respectively; 2) a review of the literature about this topic.

Material and methods: retrospective review of medical records of patients operated on by the author between 2009 and 2013. The inclusion criteria were: minimum follow-up 12 months, spinal to suprascapular nerve neurotization as the only surgery for shoulder reinnervation.

Results: 32 patients were operated, of which 13 met the inclusion criteria. There were13 men between 17 and 52 years old (average 26 years old) with blunt trauma. Five were operated by anterior approach, achieving shoulder stabilization and an average abduction of 60 degrees. Only one achieved 30 degree of external rotation. Eight underwent posterior approach, achieving shoulder stabilization and an average abduction of 69.9 degrees. Four achieved an external rotation between 28 and 55 degrees.

Discussion and conclusions: The available literature supports the use of the posterior approach for cases of late referral or possibility of double injury (in the plexus and scapular notch), since reinnervation is somewhat earlier than with the anterior approach. Likewise, the posterior approach offers better (although not ideal) recovery from external shoulder rotation. Our series is consistent with what has been published by other authors.