Obturator Nerve Transfer to the Branch of the Tibial Nerve Innervating the Gastrocnemius Muscle for the Treatment of Sacral Plexus Nerve Injury

Neurosurgery ◽  
2015 ◽  
Vol 78 (4) ◽  
pp. 546-551 ◽  
Author(s):  
Gang Yin ◽  
Huihao Chen ◽  
Chunlin Hou ◽  
Jianru Xiao ◽  
Haodong Lin
Keyword(s):  
Nerve Injury ◽  
Gastrocnemius Muscle ◽  
Tibial Nerve ◽  
Nerve Transfer ◽  
Obturator Nerve ◽  
Surgical Reconstruction ◽  
Sacral Plexus ◽  
Medial Head ◽  
Anterior Branch ◽  
The Mean

Abstract BACKGROUND: Lower-limb function is severely impaired after sacral plexus nerve injury. Nerve transfer is a useful reconstructive technique for proximal nerve injuries. OBJECTIVE: To investigate the clinical effectiveness and safety of transferring the ipsilateral obturator nerve to the branch of the tibial nerve innervating the medial head of the gastrocnemius muscle to recover knee and ankle flexion. METHODS: From 2007 to 2011, 5 patients with sacral plexus nerve injury underwent ipsilateral obturator nerve transfer as part of a strategy for surgical reconstruction of their plexuses. The mean patient age was 31.4 years (range, 19-45 years), and the mean interval from injury to surgery was 5.8 months (range, 3-8 months). The anterior branch of the obturator nerve was coapted to the branch of the tibial nerve innervating the medial head of the gastrocnemius muscle by autogenous nerve grafting. RESULTS: Patient follow-up ranged from 24 to 38 months. There were no complications related to the surgery. Three patients recovered to Medical Research Council grade 3 or better in the medial head of the gastrocnemius muscle. Thigh adduction function was not affected in any patient. CONCLUSION: Knee and ankle flexion can be achieved by transferring the anterior branch of the obturator nerve to the branch of the tibial nerve innervating the medial head of the gastrocnemius muscle, which is useful for balance. This procedure can be used as a new method for treating sacral plexus nerve injury.

scholarly journals Obturator to tibial nerve transfer via saphenous nerve graft for treatment of sacral plexus root avulsions: A cadaveric study

2020 ◽  
Vol 106 (2) ◽  
pp. 291-295 ◽  
Author(s):  
Hamid Namazi ◽  
Masood Kiani ◽  
Saeed Gholamzadeh ◽  
Amirreza Dehghanian ◽  
Dehghani Nazhvani Fatemeh
Keyword(s):  
Tibial Nerve ◽  
Nerve Transfer ◽  
Nerve Graft ◽  
Saphenous Nerve ◽  
Cadaveric Study ◽  
Sacral Plexus

Restoration of Shoulder Abduction after Radial to Axillary Nerve Transfer following Trauma or Shoulder Arthroplasty

2013 ◽  
Vol 3 (1) ◽  
pp. 99-103
Author(s):  
James A Nunley ◽  
Fraser J Leversedge ◽  
Walter H Wray ◽  
J Mack Aldridge
Keyword(s):  
Nerve Injury ◽  
Shoulder Arthroplasty ◽  
Radial Nerve ◽  
Conflicts Of Interest ◽  
Case Series ◽  
Nerve Transfer ◽  
Axillary Nerve ◽  
Shoulder Abduction ◽  
Anterior Branch ◽  
Significant Difference

ABSTRACT Purpose A loss of active shoulder abduction due to axillary nerve dysfunction may be caused by brachial plexus or isolated axillary nerve injury and is often associated with a severe functional deficit. The purpose of this study was to evaluate retrospectively the restoration of deltoid strength and shoulder abduction after transfer of a branch of the radial nerve to the axillary nerve for patients who had sustained an axillary nerve injury. Materials and methods We retrospectively reviewed all patients who underwent transfer of a branch of the radial nerve to the anterior branch of the axillary nerve at our institution, either alone or in combination with other nerve transfers, between 2004 and 2011. We identified, by chart review, 12 patients with an average follow-up of 16.7 months (6-36 months) who met inclusion criteria. Results Active shoulder abduction significantly improved from an average of 9.6° (0-60°) to 84.5° (0-160°) (p < 0.005). Average initial deltoid strength significantly improved from 0.3 (0-2) on the M scale to an average postoperative deltoid strength of 2.8 (0-5) (p < 0.005). Five of 12 (41.7%) achieved at least M4 strength and eight of 12 (66.7%) achieved at least M3 strength. No statistically significant difference was seen when subgroup analysis was performed for isolated nerve transfer vs multiple nerve transfer, mechanism of injury with MVC vs shoulder arthroplasty, age, branch of radial nerve transferred, or time from injury to surgery. No significant change in triceps strength was observed with an average of 4.9 (4-5) strength preoperatively and 4.8 (4-5) postoperatively (p = 0.34). There were three patients who achieved no significant gain in shoulder abduction or deltoid strength for unknown reasons. Conclusion Transfer of a branch of the radial nerve to the anterior branch of the axillary nerve is successful in improving deltoid strength and shoulder abduction in most patients. Our series, the largest North American series to our knowledge, has not shown outcomes as favorable as other series. Larger multicenter trials are needed. Type of study/Level of evidence This is a retrospective case series representing a level IV study. Funding No outside funding was received and the authors have no conflicts of interest to disclose. Wray WH III, Aldridge JM III, Nunley JA II, Ruch DS, Leversedge FJ. Restoration of Shoulder Abduction after Radial to Axillary Nerve Transfer following Trauma or Shoulder Arthroplasty. The Duke Orthop J 2013;3(1):99-103.

Femoral branch to obturator nerve transfer for restoration of thigh adduction following iatrogenic injury

2011 ◽  
Vol 114 (6) ◽  
pp. 1529-1533 ◽  
Author(s):  
Konstantinos Spiliopoulos ◽  
Ziv Williams
Keyword(s):  
Muscle Strength ◽  
Nerve Injury ◽  
Nerve Palsy ◽  
Rare Complication ◽  
Management Strategies ◽  
Nerve Transfer ◽  
Obturator Nerve ◽  
Pelvic Surgery ◽  
Gynecological Malignancy ◽  
Normal Gait

Obturator nerve injury is a rare complication of pelvic surgery. A variety of management strategies have been reported, with conservative measures being the preferred treatment in most cases. While nerve transfer has become more commonly used for restoring brachial plexus injuries, it has rarely been applied to the lower extremities. To the authors' knowledge, this is the first report of an obturator nerve neurotization. A patient presented 7 months after an iatrogenic right obturator nerve palsy due to pelvic surgery for gynecological malignancy. She underwent a femoral branch to obturator nerve transfer to restore right thigh adduction. Ten months after the neurotization procedure, there was electromyographic evidence of almost complete obturator nerve reinnervation. At 1 year postoperatively, the patient had regained full muscle strength on thigh adduction and a normal gait. Nerve transfer could therefore be a good option in patients with obturator nerve injury whose symptoms fail to respond to conservative medical therapy.

Partial obturator nerve transfer for femoral nerve injury: A case report

2018 ◽  
Vol 23 (1) ◽  
pp. 202-204 ◽  
Author(s):  
Naoto Inaba ◽  
Kazuki Sato ◽  
Taku Suzuki ◽  
Takuji Iwamoto ◽  
Kensuke Ochi ◽  
...  
Keyword(s):  
Case Report ◽  
Nerve Injury ◽  
Femoral Nerve ◽  
Nerve Transfer ◽  
Obturator Nerve ◽  
Femoral Nerve Injury

scholarly journals Partial Tibial Nerve Transfer to the Tibialis Anterior Motor Branch to Treat Peroneal Nerve Injury After Knee Trauma

2011 ◽  
Vol 470 (3) ◽  
pp. 779-790 ◽  
Author(s):  
Jennifer L. Giuffre ◽  
Allen T. Bishop ◽  
Robert J. Spinner ◽  
Bruce A. Levy ◽  
Alexander Y. Shin
Keyword(s):  
Nerve Injury ◽  
Tibialis Anterior ◽  
Peroneal Nerve ◽  
Tibial Nerve ◽  
Nerve Transfer ◽  
Motor Branch ◽  
Peroneal Nerve Injury ◽  
Knee Trauma

PHRENIC NERVE TRANSFER IN THE RESTORATION OF ELBOW FLEXION IN BRACHIAL PLEXUS AVULSION INJURIES

Neurosurgery ◽  
2009 ◽  
Vol 65 (suppl_4) ◽  
pp. A125-A131 ◽  
Author(s):  
Mario G. Siqueira ◽  
Roberto S. Martins
Keyword(s):  
Pulmonary Function ◽  
Brachial Plexus ◽  
Phrenic Nerve ◽  
Pulmonary Function Tests ◽  
Major Complication ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
Surgical Reconstruction ◽  
Small Series ◽  
The Mean

Abstract OBJECTIVE Phrenic nerve transfer has been used for treating lesions of the brachial plexus since 1970. Although, today, surgeons are more experienced with the technique, there are still widespread concerns about its effects on pulmonary function. This study was undertaken to evaluate the effectiveness and safety of this procedure. METHODS Fourteen patients with complete palsy of the upper limb were submitted to phrenic nerve transfer as part of a strategy for surgical reconstruction of their plexuses. Two patients were lost to follow-up, and 2 patients were followed for less than 2 years. Of the remaining 10 patients, 9 (90%) were male. The lesions affected both sides equally. The mean age of the patients was 24.8 years (range, 14–43 years), and the mean interval from injury to surgery was 6 months (range, 3–9 months). The phrenic nerve was always transferred to the musculocutaneous nerve, and a nerve graft (mean length, 8 cm; range, 4.5–12 cm) was necessary in all cases. RESULTS There was no major complication related to the surgery. Seven patients (70%) recovered functional level biceps strength (Medical Research Council grade ≥3). All of the patients exhibited a transient decrease in pulmonary function tests, but without clinical respiratory problems. CONCLUSION On the basis of our small series and data from the literature, we conclude that phrenic nerve transfer in well-selected patients is a safe and effective procedure for recovering biceps function.

Changes in Crossed Spinal Reflexes After Peripheral Nerve Injury and Repair

2002 ◽  
Vol 87 (4) ◽  
pp. 1763-1771 ◽  
Author(s):  
Antoni Valero-Cabré ◽  
Xavier Navarro
Keyword(s):  
Sciatic Nerve ◽  
Action Potential ◽  
Peripheral Nerve ◽  
Nerve Injury ◽  
Peripheral Nerve Injury ◽  
Tibialis Anterior ◽  
Tibial Nerve ◽  
Spinal Reflexes ◽  
Injury And Repair

We investigated the changes induced in crossed extensor reflex responses after peripheral nerve injury and repair in the rat. Adults rats were submitted to non repaired sciatic nerve crush (CRH, n = 9), section repaired by either aligned epineurial suture (CS, n = 11) or silicone tube (SIL4, n = 13), and 8 mm resection repaired by tubulization (SIL8, n = 12). To assess reinnervation, the sciatic nerve was stimulated proximal to the injury site, and the evoked compound muscle action potential (M and H waves) from tibialis anterior and plantar muscles and nerve action potential (CNAP) from the tibial nerve and the 4th digital nerve were recorded at monthly intervals for 3 mo postoperation. Nociceptive reinnervation to the hindpaw was also assessed by plantar algesimetry. Crossed extensor reflexes were evoked by stimulation of the tibial nerve at the ankle and recorded from the contralateral tibialis anterior muscle. Reinnervation of the hindpaw increased progressively with time during the 3 mo after lesion. The degree of muscle and sensory target reinnervation was dependent on the severity of the injury and the nerve gap created. The crossed extensor reflex consisted of three bursts of activity (C1, C2, and C3) of gradually longer latency, lower amplitude, and higher threshold in control rats. During follow-up after sciatic nerve injury, all animals in the operated groups showed recovery of components C1 and C2 and of the reflex H wave, whereas component C3 was detected in a significantly lower proportion of animals in groups with tube repair. The maximal amplitude of components C1 and C2 recovered to values higher than preoperative values, reaching final levels between 150 and 245% at the end of the follow-up in groups CRH, CS, and SIL4. When reflex amplitude was normalized by the CNAP amplitude of the regenerated tibial nerve, components C1 (300–400%) and C2 (150–350%) showed highly increased responses, while C3 was similar to baseline levels. In conclusion, reflexes mediated by myelinated sensory afferents showed, after nerve injuries, a higher degree of facilitation than those mediated by unmyelinated fibers. These changes tended to decline toward baseline values with progressive reinnervation but still remained significant 3 mo after injury.

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