Spinal accessory nerve transfer for shoulder abduction has no benefit over supraclavicular exploration and nerve grafting in brachial plexus birth injury: a systematic review
IntroductionBrachial plexus birth injury (BPBI) has an incidence of 0.9 per 1,000 live births in the population. Techniques for repair classically include supraclavicular exploration and nerve grafting (SENG) and more recently nerve transfer, namely of the spinal accessory nerve (SAN) to the suprasc...
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Frontiers Media S.A.
2024-12-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2024.1426105/full |
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| author | Dhruv Mendiratta Rohan Singh George Abdelmalek Krittika Pant Alice Chu Aleksandra McGrath Aleksandra McGrath |
| author_facet | Dhruv Mendiratta Rohan Singh George Abdelmalek Krittika Pant Alice Chu Aleksandra McGrath Aleksandra McGrath |
| author_sort | Dhruv Mendiratta |
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| description | IntroductionBrachial plexus birth injury (BPBI) has an incidence of 0.9 per 1,000 live births in the population. Techniques for repair classically include supraclavicular exploration and nerve grafting (SENG) and more recently nerve transfer, namely of the spinal accessory nerve (SAN) to the suprascapular nerve (SSN) to improve functional outcomes such as glenohumeral abduction and external rotation. This systematic review was conducted to evaluate whether spinal accessory nerve transfer produced significantly better outcomes for shoulder abduction in BPBI.MethodsA search was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analysis Individual Patient Data guidelines. Standardized comparisons were made using the Mallet Score for shoulder abduction.Results10 full-text articles with itemized patient outcome measures were selected. 110 patients were identified with 51 patients in the SENG group and 59 patients in the SAN transfer group. The mean shoulder abduction Mallet score in the SENG group was 3.50 ± 0.84, while the mean Mallet score in the SAN transfer group was 3.58 ± 0.77, which displayed no significant differences (p = 0.9012). There was no significant relationship between the age at time of surgery and post-operative Mallet scores for shoulder abduction after SENG (p = 0.3720).DiscussionOur systematic review found that there was no difference observed in post-operative outcomes of shoulder abduction when comparing SAN transfer and nerve grafting. Continued support for nerve grafting lies in the argument that it incorporates the patient's native neuroanatomy and allows for sensory reinnervation. |
| format | Article |
| id | doaj-art-ac65f9f7f20c4670ad5cb171c2193e70 |
| institution | Kabale University |
| issn | 2296-2360 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Pediatrics |
| spelling | doaj-art-ac65f9f7f20c4670ad5cb171c2193e702024-12-19T04:21:31ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602024-12-011210.3389/fped.2024.14261051426105Spinal accessory nerve transfer for shoulder abduction has no benefit over supraclavicular exploration and nerve grafting in brachial plexus birth injury: a systematic reviewDhruv Mendiratta0Rohan Singh1George Abdelmalek2Krittika Pant3Alice Chu4Aleksandra McGrath5Aleksandra McGrath6Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, Newark, NJ, United StatesDepartment of Orthopaedic Surgery, Rutgers New Jersey Medical School, Newark, NJ, United StatesDepartment of Orthopaedic Surgery, Rutgers New Jersey Medical School, Newark, NJ, United StatesDepartment of Orthopaedic Surgery, Rutgers New Jersey Medical School, Newark, NJ, United StatesDepartment of Orthopaedic Surgery, Rutgers New Jersey Medical School, Newark, NJ, United StatesDepartment of Clinical Sciences, Umeå University, Umeå, SwedenDepartment of Surgical and Perioperative Sciences, Umeå University, Umeå, SwedenIntroductionBrachial plexus birth injury (BPBI) has an incidence of 0.9 per 1,000 live births in the population. Techniques for repair classically include supraclavicular exploration and nerve grafting (SENG) and more recently nerve transfer, namely of the spinal accessory nerve (SAN) to the suprascapular nerve (SSN) to improve functional outcomes such as glenohumeral abduction and external rotation. This systematic review was conducted to evaluate whether spinal accessory nerve transfer produced significantly better outcomes for shoulder abduction in BPBI.MethodsA search was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analysis Individual Patient Data guidelines. Standardized comparisons were made using the Mallet Score for shoulder abduction.Results10 full-text articles with itemized patient outcome measures were selected. 110 patients were identified with 51 patients in the SENG group and 59 patients in the SAN transfer group. The mean shoulder abduction Mallet score in the SENG group was 3.50 ± 0.84, while the mean Mallet score in the SAN transfer group was 3.58 ± 0.77, which displayed no significant differences (p = 0.9012). There was no significant relationship between the age at time of surgery and post-operative Mallet scores for shoulder abduction after SENG (p = 0.3720).DiscussionOur systematic review found that there was no difference observed in post-operative outcomes of shoulder abduction when comparing SAN transfer and nerve grafting. Continued support for nerve grafting lies in the argument that it incorporates the patient's native neuroanatomy and allows for sensory reinnervation.https://www.frontiersin.org/articles/10.3389/fped.2024.1426105/fullbrachial plexus birth injuryperipheral nervesurgeryoutcomenerve graftnerve transfer |
| spellingShingle | Dhruv Mendiratta Rohan Singh George Abdelmalek Krittika Pant Alice Chu Aleksandra McGrath Aleksandra McGrath Spinal accessory nerve transfer for shoulder abduction has no benefit over supraclavicular exploration and nerve grafting in brachial plexus birth injury: a systematic review Frontiers in Pediatrics brachial plexus birth injury peripheral nerve surgery outcome nerve graft nerve transfer |
| title | Spinal accessory nerve transfer for shoulder abduction has no benefit over supraclavicular exploration and nerve grafting in brachial plexus birth injury: a systematic review |
| title_full | Spinal accessory nerve transfer for shoulder abduction has no benefit over supraclavicular exploration and nerve grafting in brachial plexus birth injury: a systematic review |
| title_fullStr | Spinal accessory nerve transfer for shoulder abduction has no benefit over supraclavicular exploration and nerve grafting in brachial plexus birth injury: a systematic review |
| title_full_unstemmed | Spinal accessory nerve transfer for shoulder abduction has no benefit over supraclavicular exploration and nerve grafting in brachial plexus birth injury: a systematic review |
| title_short | Spinal accessory nerve transfer for shoulder abduction has no benefit over supraclavicular exploration and nerve grafting in brachial plexus birth injury: a systematic review |
| title_sort | spinal accessory nerve transfer for shoulder abduction has no benefit over supraclavicular exploration and nerve grafting in brachial plexus birth injury a systematic review |
| topic | brachial plexus birth injury peripheral nerve surgery outcome nerve graft nerve transfer |
| url | https://www.frontiersin.org/articles/10.3389/fped.2024.1426105/full |
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