American Society for Peripheral Nerve
ASPN Home ASPN Home Past & Future Meetings Past & Future Meetings

Back to 2023 Abstracts


Early Nerve Grafting is Superior to Late Oberlin Transfer in C5-C7(C8) Lesions
Justus L Groen, MD PhD1; Willem Pondaag, MD PhD2; Martijn J.A. Malessy, MD, PhD3
1Department of Neurosurgery, Leiden University Medical Center, Leiden, Netherlands; 2Neurosurgery, Leiden University Medical Center, Leiden, Netherlands; 3Neurosurgery, Department of Neurosurgery, Leiden University Medical Center, Leiden, Netherlands

Introduction Distal fascicular nerve transfers are generally considered treatment of choice in restoration of biceps function in non-flail brachial plexus injury in adults (ATBPI). Surgical treatment is generally delayed for more than three months to await spontaneous recovery. Since 2009 we strife to operate as early as possible when the clinical and radiological suspicion of supraclavicular neurotmesis or root avulsion is high. Here we evaluate the results of supraclavicular grafting and fascicular nerve transfer for recovery of elbow flexion in non-flail brachial plexus traction lesions in relation to timing.
Methods We performed a retrospective chart review of all patients who were surgically treated for ATBPI between 2009-2019. Flail arm patients were excluded and only C5C6, C5C6C7 and C5C6C7C8 lesions were analyzed. Biceps function was the primary target of nerve surgery. We compared outcome of biceps recovery after supraclavicular grafting vs distal fascicular transfer in relation to the interval between trauma and surgery: ultra-early (< 2 weeks), early (2 weeks-3 months), 3-6 months and late (> 6 months). Results We surgically treated 140 ATBPI patients of which 68 (grafting 18, nerve transfer 50) met the inclusion criteria. There was no significant difference in elbow flexion MRC?3 between the grafting group and transfer group: 89% vs 77% (Fisher Exact p value= 0.20). Patients reached MRC 4 more often after transfer than grafting, 60% vs 33% respectively. This difference was not statistically significant (p= 0.06). Grafting and transfer are more effective in the ultra-early and early groups, as compared to late surgery (p=0.0042). Elbow flexion following grafting within 6 months was significantly better than Oberlin transfer after 6 months (p=0.0116). In the grafting group, 5/18 patients progressed to have no C8 recovery at follow up. In these patients fascicular transfer would not have been a viable option. All these 5 patients developed a fair (n=3) or good (n=2) elbow flexion after grafting.
Conclusions Nerve grafting when performed early is superior to late nerve transfer in upper brachial plexus lesions. Both techniques provide satisfactory results for biceps function if performed within six months after trauma. Based on our results we advocate early plexus exploration in C5-C7(C8) plexus lesions


Back to 2023 Abstracts