Comparison between the anterior and posterior approach for transfer of the spinal accessory nerve to the suprascapular nerve in late traumatic brachial plexus injuries.

OBJECTIVE: To evaluate the transfer of the spinal accessory nerve to the suprascapular nerve through the anterior or posterior approach in patients with late traumatic brachial plexus injuries.

METHODS: This study includes patients with late brachial plexus injuries that underwent a spinal accessory-to-suprascapular nerve transfer. They were divided into two equal groups, A and B, in which the spinal accessory nerve was transferred to the suprascapular nerve, respectively, through the anterior or posterior approach. Narakas's scale for assessment of the abduction of the arm and rotation of the shoulder was used.

RESULTS: We studied 20 male patients with an age ranging from 18 to 42 years. In groups A and B, the mean age was 28 ± 5.5 and 26 ± 7.7 years, respectively. The time interval between injury and surgery was 9.5 ± 1.6 and 10.9 ± 2.5 months for groups A and B (p = 0.12), respectively. In the 20 patients in groups A and B, we obtained a strength of shoulder abduction at 30°, respectively, M3 (in 4 and 5), M2 (in 4 and 2), M1 (in 2 and 2) and M0 (in zero and 1) (p = 0.5). Regarding external rotation, group A showed M2 in only one patient and M0 in nine, while in group B, M3, in four; M2, in three; and M0, in three. In group B, the best results were observed in relation to the recovery of external rotation (p = 0.008).

CONCLUSIONS: Better results in terms of external arm rotation were obtained when spinal accessory-to-suprascapular nerve transfer was performed using the posterior approach.