title: Spinal accessory nerve transfer outperforms cervical root grafting for suprascapular nerve reconstruction in neonatal brachial plexus palsy.
abstract: BACKGROUND
  The authors evaluated long-term shoulder function in patients with neonatal brachial plexus palsy undergoing suprascapular nerve reconstruction with cervical root grafting or spinal accessory nerve transfer.
  
  
  METHODS
  A retrospective review was performed on all infants presenting with neonatal brachial plexus palsy between 1994 and 2010. Functional outcomes were compared by type of suprascapular nerve reconstruction.
  
  
  RESULTS
  Seventy-four patients met the inclusion criteria (46 transfers, 28 grafts). Both groups presented with an active movement scale score of 2.0 for shoulder abduction and 0.0 for external rotation. Postoperative follow-up was 9.0 years for the graft group and 6.7 years for the transfer group. Both groups achieved an active movement scale score of 5.0 for shoulder abduction at 12, 24, and 36 months postoperatively. Active movement scale scores for shoulder external rotation were 1.0, 2.0, and 2.5 for the graft group versus 2.0, 2.0, and 3.0 for the transfer group at 12, 24, and 36 months postoperatively. None of these differences reached statistical significance. Composite Mallet scores were 13.0 for the graft group versus 15.0 for the transfer group at 3 years (p = 0.06) and 13.0 for the graft group versus 16.0 for the transfer group at 5 years postoperatively (p = 0.07). Secondary shoulder surgery was performed on 57.1 percent (16 of 28) of patients with grafts compared with 26.1 percent (12 of 46) of patients with transfers (OR, 3.17; p = 0.02).
  
  
  CONCLUSIONS
  Suprascapular nerve reconstruction by cervical root grafting results in poorer shoulder function and a two-fold increase in secondary shoulder surgery compared with spinal accessory nerve transfer.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: Victoria, Australia From the Department of Plastic and Maxillofacial Surgery, Royal Children's Hospital Melbourne.
authors.forename: Mitchel
authors.initials: M
authors.lastname: Seruya
authors.forename: Shi Hong
authors.initials: SH
authors.lastname: Shen
authors.forename: Sibon
authors.initials: S
authors.lastname: Fuzzard
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Coombs
authors.forename: David B
authors.initials: DB
authors.lastname: McCombe
authors.forename: Bruce R
authors.initials: BR
authors.lastname: Johnstone
mesh_terms: D000055:Accessory Nerve / Q000601:surgery*; D020516:Brachial Plexus Neuropathies / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D016067:Nerve Transfer / Q000379:methods*; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012782:Shoulder / Q000294:innervation*; D012785:Shoulder Joint / Q000503:physiopathology; D013126:Spinal Nerve Roots / Q000601:surgery*; D013997:Time Factors
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