Posterior approach for accessory-suprascapular nerve transfer: an electrophysiological outcomes study

2012 ◽  
Vol 38 (3) ◽  
pp. 242-247 ◽  
Author(s):  
J. Rui ◽  
X. Zhao ◽  
Y. Zhu ◽  
Y. Gu ◽  
J. Lao
Keyword(s):  
Anterior Approach ◽  
Posterior Approach ◽  
Nerve Transfer ◽  
Suprascapular Nerve ◽  
Significant Difference ◽  
Potential Alternative ◽  
Motor Unit Action ◽  
Low Incidence ◽  
Electrophysiological Examination ◽  
Approach Group

The aim of this study was to retrospectively investigate the electrophysiological results obtained after employing the posterior approach for spinal accessory nerve-suprascapular nerve (SAN-SSN) transfer, and to compare this with the traditional anterior approach. SAN-SSN transfer was performed in 74 patients with brachial plexus injury. The posterior approach was used in 35 patients and the anterior approach was used in 39 patients. Electrophysiological examination was conducted and analyzed postoperatively. There was no significant difference between approaches in the time it took for the infraspinatus to show low-incidence motor unit action potentials (MUAPs) and an incomplete interference pattern. In addition, the final ratio of patients that showed regeneration potential of the infraspinatus was not significantly different between the approaches. Furthermore, latency and wave amplitude showed a linear regression with post-operative time in the posterior approach group. In the posterior approach group, the final abduction of the shoulder was positively correlated with the amplitude. The posterior approach for SAN-SSN is an effective potential alternative technique that may be appropriate for some clinical situations.

Pathological findings identified during the posterior approach to the spinal accessory nerve after high-energy trauma

2021 ◽  
pp. 175319342110396
Author(s):  
Dominic M. Power ◽  
Devanshi Jimulia ◽  
Paul Malone ◽  
Colin Shirley ◽  
Tahseen Chaudhry
Keyword(s):  
Anterior Approach ◽  
Posterior Approach ◽  
Nerve Transfer ◽  
Suprascapular Nerve ◽  
High Energy ◽  
Pathological Findings ◽  
Level Of Evidence ◽  
Suprascapular Notch ◽  
High Energy Trauma ◽  
Spinal Accessory

The spinal accessory to suprascapular nerve transfer is a key procedure for restoring shoulder function in upper brachial plexus injuries and is typically undertaken via an anterior approach. The anterior approach may miss injury to the suprascapular nerve about the suprascapular notch, which may explain why functional outcomes are often limited. In 2014 we adopted a posterior approach to enable better visualization of the suprascapular nerve at the notch. Over the next 6 years we have used this approach for 20 explorations after high-energy trauma. In 7/20 we identified abnormalities at the level of the suprascapular ligament, which we would not have identified with an anterior approach: there were two ruptures, two neuromas-in-continuity and three cases of scar encasement, necessitating neurolysis. Nerve transfer could be undertaken distal to the suprascapular notch, bypassing the site of injury. These pathological findings support the wider adoption of the posterior approach in cases of high-energy trauma. Level of evidence: IV

Heterotopic ossification after total hip arthroplasty: radiological comparison between a direct anterior approach without an orthopaedic table and a posterior approach

2020 ◽  
pp. 112070002097079
Author(s):  
Naïm Zran ◽  
Etienne Joseph ◽  
Gabriel Callamand ◽  
Xavier Ohl ◽  
Renaud Siboni
Keyword(s):  
Soft Tissue ◽  
Heterotopic Ossification ◽  
Surgical Approach ◽  
Anterior Approach ◽  
Posterior Approach ◽  
Direct Anterior Approach ◽  
Soft Tissue Release ◽  
Surgical Trauma ◽  
Total Hip ◽  
Significant Difference

Introduction: Heterotopic ossification (HO) occurs in almost ⅓ of total hip arthroplasties (THAs). A direct anterior approach (DAA) with an orthopaedic table is less likely to cause HO than a posterior approach. Without an orthopaedic table, the exposure of the femur requires additional soft tissue release. Soft tissue trauma leads to the production of HO inductors. Our study evaluated the incidence of HO 6 months after THA and compared the results between DAAs without an orthopaedic table and posterior approaches. Methods: Retrospectively, 164 consecutive, primary THAs were included: 76 through a posterior approach and 88 through a DAA. The main objective was to measure the presence of HO on pelvis radiography 6 months after surgery. Results: The incidence of HO was significantly higher in the DAA group than in the posterior approach group (47.7% vs. 27.6%, respectively; p  < 0.01). The overall incidence of HO was 38.4%. No significant difference was found between the 2 approaches regarding the severity of HO. No significant risk factor for HO was identified other than the surgical approach. Discussion: In our study, the incidence of HO after THA in patients undergoing DAA without an orthopaedic table was higher than in patients undergoing a posterior approach after 6 months of follow-up. This result is closely related to the surgical trauma. It suggests that the minimally invasive feature of a surgical approach cannot be dissociated from the overall conditions in which it is performed.

Posterior approach technique for accessory-suprascapular nerve transfer: A cadaveric study of the anatomical landmarks and number of myelinated axons

2007 ◽  
Vol 20 (2) ◽  
pp. 140-143 ◽  
Author(s):  
D. Pruksakorn ◽  
K. Sananpanich ◽  
S. Khunamornpong ◽  
S. Phudhichareonrat ◽  
P. Chalidapong
Keyword(s):  
Posterior Approach ◽  
Nerve Transfer ◽  
Suprascapular Nerve ◽  
Cadaveric Study ◽  
Anatomical Landmarks ◽  
Myelinated Axons

scholarly journals Outcome of double nerve transfer close to target muscle both for shoulder abduction and elbow flexion in early C5 –C6 Brachial Plexus injury.

2020 ◽  
Vol 27 (07) ◽  
pp. 1442-1447
Author(s):  
Husnain Khan ◽  
Muhammad Shafique ◽  
Zahid Iqbal Bhatti ◽  
Tehseen Ahmad Cheema
Keyword(s):  
Brachial Plexus ◽  
Posterior Approach ◽  
Brachial Plexus Injury ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
Suprascapular Nerve ◽  
Axillary Nerve ◽  
Shoulder Abduction ◽  
Motor Branch ◽  
Nerve Transfers

Adult brachial plexus injury is a now a common problem due to high incidence of motorbike accidents. Among all types, C 5 and C6 (upper brachial plexus injury) is the most common. If the patient present within 6 months then nerve transfer is the preferred treatment. However, there are different options for nerve transfer and different approaches for surgery. Objectives: The objective of the study was to share our experience of nerve transfer close to target muscles in upper brachial plexus injury. Study Design: Quaisi experimental study. Setting: National Orthopaedic Hospital, Bahawalpur. Period: January 2015 to June 2018. Material & Methods: Total 32 patients were operated with isolated C5 and C6 injury. In all patients four nerve transfers were done. For shoulder abduction posterior approach was used and accessory to suprascapular nerve and one of motor branch of radial to axillary nerve were transferred. Modified Oberlin transfer was done for elbow flexion. Both shoulder abduction and elbow flexion was graded according to medical research council grading system. Results: After one year follow up more than 75% of the patients showed good to normal shoulder abduction and 87.50% showed good to normal elbow flexion. Residual Median nerve damage was noted only in two patients (6.25%). Conclusion: If there is no evidence of recovery up to three months early nerve transfer should be considered, ideal time is 3-6 months. Nerve transfer close to target muscle yields superior results. The shoulder stabilizers and abductors should ideally be innervated by double nerve transfer through posterior approach. Similarly double fascicular transfer (modified Oberlin) should be done for elbow flexion.

Traumatic Suprascapular Nerve Injury at the Notch—A Reason for the Posterior Approach in Brachial Plexus Reconstruction

2017 ◽  
Vol 33 (08) ◽  
pp. 592-595
Author(s):  
Marc Seifman ◽  
Scott Ferris
Keyword(s):  
Brachial Plexus ◽  
Posterior Approach ◽  
External Rotation ◽  
Nerve Transfer ◽  
Suprascapular Nerve ◽  
Shoulder Function ◽  
Senior Author ◽  
Spinal Accessory Nerve ◽  
Accessory Nerve ◽  
Spinal Accessory

Background Optimal dynamic reconstruction of shoulder function requires a functional suprascapular nerve (SSN). Nerve transfer of the distal spinal accessory nerve (dSAN) to the SSN will in many cases restore very good supraspinatus and infraspinatus function. One potential cause of failure of this nerve transfer is an unrecognized more distal injury of the SSN. An anterior approach to this transfer does not allow for visualization of the nerve at the scapular notch which is a disadvantage when compared with a posterior approach to the SSN. Methods All patients of the senior author (S.F.) with traumatic brachial plexus injuries undergoing spinal accessory nerve to SSN transfer via the posterior approach were analyzed. Results Of the 58 patients, 11 (19.0%) demonstrated abnormal findings at the notch. In two of these 11 patients (18.2%), reconstruction was abandoned due to severe injury of the nerve. There was a higher rate of clavicular fractures in patients with SSN injuries at the notch, compared with no SSN injury at the notch (63.6 vs. 12.8%). Conclusion The dSAN to SSN transfer is a reliable reconstruction for restoration of shoulder external rotation and abduction. There is a high proportion of injuries to the nerve at the notch, which can be best appreciated from a posterior approach. The authors, therefore, advocate a posterior approach for this nerve transfer.

scholarly journals ASSESSMENT OF THE RESULTS OF ACCESSORY TO SUPRASCAPULAR NERVE TRANSFER

2018 ◽  
Vol 26 (5) ◽  
pp. 332-334
Author(s):  
Yussef Ali Abdouni ◽  
Gabriel Faria Checoli ◽  
Horacio Cardoso Salles Filho ◽  
Antonio Carlos da Costa ◽  
Ivan Chakkour ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Pain Control ◽  
Constant Score ◽  
Nerve Transfer ◽  
Suprascapular Nerve ◽  
Surgical Reconstruction ◽  
Level Of Evidence ◽  
Nerve Transfers ◽  
Significant Difference ◽  
Shoulder Stability

ABSTRACT Objective: Nerve transfers are an alternative in the reconstruction of traumatic brachial plexus injuries. In this study, we report the results of branchial plexus reconstruction using accessory to suprascapular nerve transfer. Methods: Thirty-three patients with traumatic brachial plexus injuries underwent surgical reconstruction with accessory to suprascapular nerve transfers. The patients were divided into groups in which surgery was performed either within 6 months after the injury or more than 6 months after the injury. Results were assessed using the Constant score. Results: There was no significant difference between the groups with respect to the Constant score. Conclusion: Accessory to suprascapular nerve transfer was not an efficient method for recovering active ROM or strength in the shoulder. However, it effectively improved pain control and shoulder stability. Level of evidence II, Retrospective Study.

Safety and efficacy of inferoposterior access approach to the renal pedicle during transperitoneal laparoscopic radical nephrectomy: A retrospective comparative analysis at a single institution

2020 ◽  
pp. 205141582094553
Author(s):  
Xiao-Bao Cheng ◽  
Wayne Lam ◽  
Zhen-Quan Lu ◽  
Richard Lo
Keyword(s):  
Comparative Analysis ◽  
Radical Nephrectomy ◽  
Anterior Approach ◽  
Operative Time ◽  
Renal Vasculature ◽  
Safety And Efficacy ◽  
Laparoscopic Radical Nephrectomy ◽  
Renal Pedicle ◽  
Significant Difference ◽  
Approach Group

Purpose To assess the safety and efficacy of transperitoneal laparoscopic radical nephrectomy using an inferoposterior approach to the renal pedicle. Materials and methods A retrospective review of 89 patients who underwent transperitoneal laparoscopic radical nephrectomy by a single surgeon between June 2014 and December 2019 at a single urological unit was carried out. Access to the renal pedicle was via the inferoposterior approach in 48 cases (study group) and 41 were approached via the conventional anterior approach (control group). Patient demographics, intra-operative anatomical findings, and procedural details including operative time on renal pedicles and post-operative outcomes were recorded. Post-operative complications were recorded and classified according to the Clavien-Dindo classification. A comparative analysis between the two groups was performed using Chi-square test and t-test. Results The inferoposterior approach group had a shorter operative time (132.85±26.65 min vs 153.46±39.94 min; p<0.01), which could be attributed to the shorter time spent operating on the renal vasculature (46.31±6.16 min vs 64.46±7.64 min; p<0.01). Lower average blood loss was also observed in the inferoposterior approach group (42 ml vs 62 ml; p<0.05). No significant difference was identified concerning the mean patient age, body mass index, tumor size, number of renal vessels identified, and post-operative length of stay between the two groups. None of the patients required conversion to open. Conclusion Inferoposterior approach to access the renal pedicle during transperitoneal laparoscopic radical nephrectomy is a safe and effective technique, which shortens the operative time when compared to the conventional anterior approach. Level of evidence: Level 3b.

scholarly journals Is Anterior Approach Alone With Mesh Appropriate for Incarcerated Groin Hernias?: A Retrospective Analysis

2018 ◽  
Vol 103 (7-8) ◽  
pp. 351-354
Author(s):  
Baris Yildiz ◽  
Serkan Akbulut ◽  
Huseyin Berkem ◽  
Bulent Yuksel ◽  
Tezcan Akin ◽  
...  
Keyword(s):  
Anterior Approach ◽  
Posterior Approach ◽  
Demographic Data ◽  
Emergency Unit ◽  
Lichtenstein Repair ◽  
Incarcerated Inguinal Hernia ◽  
Significant Difference ◽  
Male Patients ◽  
Definitive Surgery ◽  
Groin Hernias

This study evaluates whether an extra incision is needed in addition to the standard inguinal incision for the surgery of incarcerated groin hernias. Patients with groin hernias present to an emergency unit when their hernia incarcerates or strangulates. The classical approach to such presentations is open surgery, and a second incision is sometimes needed to resect the strangulated organ. This is a retrospective study enrolling 218 patients treated for incarcerated groin hernias at a state hospital between 2006 and 2010. Data collected were demographic data, type and location of hernia, type of surgery and anesthesia, type of incision, need for resection, and preoperative complications. A total of 37.9% of female and 13.2% of male patients had resection of an abdominal organ. Of patients with incarcerated groin hernias, 20% (n = 43) had resection. Omentum was the most commonly resected organ (n = 19; 8.8%), followed by small intestine (n = 11; 5.1%), bladder, appendix, lymphadenopathy, and preperitoneal fat (each n = 3 and 1.4%). Of 218 patients, 10 (4.58%) needed a secondary incision for hernia reduction. All of these patients had their surgery with one of the anterior approach techniques. There was no statistically significant difference (P = 0.4) in need for secondary incision between the anterior and posterior approach techniques. In recent years, posterior approach for incarcerated groin hernias was deemed advantageous because it did not necessitate an additional incision for definitive surgery. Our study showed that in the treatment of incarcerated inguinal hernia, Lichtenstein repair is also a safe and easy alternative, without the need for a second incision.

scholarly journals Comparative study of the clinical effect and safety of anterior surgical approach and posterior surgical approach in the treatment of thoracolumbar spinal fracture

Open Medicine ◽  
2015 ◽  
Vol 10 (1) ◽  
Author(s):  
Zhang Dengfeng ◽  
Wu Haojie ◽  
Wang Xiao
Keyword(s):  
Surgical Approach ◽  
Anterior Approach ◽  
Posterior Approach ◽  
Clinical Effect ◽  
Spinal Fractures ◽  
Fusion Rate ◽  
Spinal Fracture ◽  
Control Group ◽  
Cobb’S Angle ◽  
Approach Group

AbstractThe clinical effect and safety of the anterior surgical approach and posterior surgical approach in the treatment of thoracolumbar spinal fracture was compared. Retrospective analyses of clinical data for 91 patients observed from March 2010 to September 2014 were made. The pre-operation and post-operation comparisons between two sets of Cobb’s angle, affected vertebra height, Frankel’s classification of spinal nerves, motion functions, and tactile functions showed statistically significant differences (P<0.05). After having the operation, the Cobb’s angle and affected vertebra height of the patient in the anterior approach group were both significantly higher than that of patients in the posterior approach group (P<0.05). The bone graft fusion rate of the patients in the anterior approach group 3 months after operation was higher than that of patients in the control group while the status of complications was worse than that of patients in the posterior approach group, both with a remarkable difference (P<0.05). Both the anterior surgical approach and posterior surgical approach have good clinical outcome for spinal fractures but they all have their respective adaption diseases. The key in the treatment of thoracolumbar spinal fractures lies in choosing proper operative approach.

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