Nerve Transfers for Brachial Plexus Injuries Reconstruction – Our Experience

Amir Arami 1,2 Shelly Gurevitz 1,2 Ram Palti 1,2 Batia Yaffe 1,2
1Hand Surgry, Sheba Medical Center, Tel-Hashomer, Israel
2Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

Introduction: There is a wide spectrum of severity in brachial plexus injuries, both obstetrical and in adults. Indications for surgical intervention remain controversial and vary widely by institution. Nerve transfers are gaining popularity as a primary surgical approach for brachial plexus reconstruction. In this study we share our experience with nerve transfers for brachial plexus injuries, regarding outcome, prognostic factors and risk factors for failure.

Methods: We retrospectively reviewed all patients treated with nerve transfers for brachial plexus injuries (both obstetrical and in adults) from Jan 2008 to May 2015, with at least one documented follow up visit 12 months or later after the surgery. Digital charts were reviewed including pre-treatment outpatient clinical reports, surgical reports and post-treatment outpatient clinic reports.

Results: A total number of 33 nerve transfer procedures that were performed in 21 patients (13 patients with obstetric and 8 with adult brachial plexus injuries) were available for this study. 14 procedures and 7 procedures were performed for biceps and suprascapular nerve (SSN) neurotization, respectively. A bimodal distribution of outcomes was noticed: either MRC grade 3 and above or MRC grade 0. Nine biceps neurotizations and 5 SSN neurotizations were documented as MRC grade 3 or higher. Prognostic factors for MRC muscle grade 3 and above for biceps and SSN neurotizations are C5-C6 lesions as opposed to global paralysis; ulnar or median nerve as donor for biceps and spinal accessory nerve (SAN) for SSN neurotizations and possibility of direct nerve cooptation. Of notice, delayed surgery and surgery in adults didn’t preformed worse.

Discussion: Nerve transfers are a viable and attractive option for primary reconstruction after brachial plexus injuries, both obstetric and in adults. Although good results were obtained as measured by MRC grade of neurotized muscle, functional and disability scores were not assessed and further study is required.