Spinal Accessory Nerve to Suprascapular Nerve Transfer: A Comparison of the Anterior and Posterior Approach
Kevin T Rezzadeh, BA, New York University School of Medicine, New York, NY, Megan Donnelly, BS, NYU School of Medicine, New York, NY, David Daar, MD, New York University Langone Health, New York, NY and Jacques Hacquebord, MD, NYU Langone Medical Center, New York, NY
Introduction:
Studies comparing the newer posterior approach of spinal accessory nerve (SAN) to suprascapular nerve nerve (SSN) transfer to the traditional anterior approach have shown mixed results. The purpose of this study is to determine if surgical approach affects postoperative shoulder abduction outcomes.
Methods:
A systematic review of the literature was conducted according to PRISMA guidelines. Inclusion criteria were studies reporting outcomes on patients undergoing SAN to SSN nerve transfer. Patients were excluded for any of the following reasons: age under 13, nerve transfer for reanimation of the shoulder other than SAN to SSN and axillary (AXN) neurotization with the use of any donor nerve and had less than 12 months of follow-up postoperatively. Patients were divided into two groups based on the surgical approach utilized for neurotization. Pooled analysis was performed, and primary outcomes were shoulder abduction Medical Research Council (MRC) score and range of motion (ROM). The two groups were compared using independent samples t test and chi-squared test.
Results:
There were 85 patients from six studies included in this pooled analysis. Patients who underwent the anterior approach had greater extent of injury and higher utilization of ICN nerves for axillary nerve neurotization (Total Brachial Plexus Injury/ICN use: 17.4% vs. 0.0%, p<0.006). Patients who underwent the posterior approach had intraoperative surgical decompression more frequently, There were no other significant differences in demographic variables. Outcomes did not differ significantly between the two groups (Anterior vs. Posterior: [ROM] 109.6 vs. 104.3, p=0.663; [MRC] 3.5 vs 2.8, p=0.211).
Conclusion:
Despite the ability to decompress the SSN at the spinoglenoid notch and the less severe injury pattern, the posterior surgical approach to SAN to SSN nerve transfer does not appear to improve outcomes with regards to shoulder strength or range of motion. Further study is warranted to identify the optimal technique.
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