gms | German Medical Science

Objectives/Interrogation: Brachial Plexus Birth Injury (BPBI) affects approximately 1.5 children per 1000 live births in the United States. While exploration and nerve grafting has been the mainstay of treatment for BPBI, nerve transfers have gained popularity as they avoid donor site morbidity and place the donor nerve close to the endplate, therefore minimize re-innervation time. Nerve transfers for shoulder function involving the Spinal accessory to Suprascapular nerve transfer (SAN-SSN) have been frequently used in BPBI, often simultaneously with other procedures, but there is limited data from isolated procedures, which are not performed with any other nerve or tendon surgery. We describe the shoulder function recovery of 53 patients that were operated upon at three medical centers and underwent an SAN-SSN through either an anterior or posterior approach.

Methods: We retrospectively reviewed the cases of 53 patients at three institutions who had undergone a SAN- SSN after BPBI. Inclusion criteria were patients with BPBI who underwent a solitary SAN-SSN and who had bot preoperative and minimum 36 months postoperative Active Movement Scale (AMS) scores. Patients for whom the primary surgery involved nerve reconstruction or tendon transfers were excluded. The primary outcome measures were the AMS scores for shoulder abduction, forward flexion and external rotation and secondary outcomes included the need for further shoulder surgery to improve function.

Results and Conclusions: 42 (79.2%) patients obtained functional shoulder motion (AMS>5) following surgery, with 23 (43.4%) patient obtaining full recovery of shoulder function against gravity (AMS=7). 40 (75.5%) patients did not proceed to further tendon transfers or corrective osteotomies to augment shoulder function. The anterior and posterior approaches were both found to be equally effective for isolated SAN-SSN in BPBI. In a multivariable binomial logistic regression the institution at which the surgery was conducted was found to be the only statistically significant factor to affect the ER functional outcome (P=0.04).

SAN-SSN were able to recover functional shoulder motion in brachial plexus birth injuries and prevent tendon transfer procedures and corrective osteotomies in approximately 80% patients. The institution where the surgery was performed was shown to be independently correlated to outcomes, which is likely due to variations in AMS scoring among institutions. Outcomes continue to improve throughout the first three postoperative years.