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Posterior Approach to Neurotize Suprascapular Nerve by Spinal Accessory Nerve

Background: Surgical reconstruction of the shoulder is a high priority in patients with total brachial plexus injuries. This is not only because functional control of the shoulder is of paramount importance, but also because of the overall reduced success of reinnervation of muscles below the elbow. Objective: This study aimed to neurotize suprascapular nerve by spinal accessory nerve through posterior approach. Patients and methods: This prospective cohort study was conducted in the Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Zagazig University within the period from November 2018 to July 2019. Twelve patients were included in the present study. All patients were exposed to traumatic brachial plexus injuries. Results: our study showed progressive improvement of shoulder flexion, abduction and external rotation. By the comparison between pre- and postoperative range of movement. It was recorded that the mean value of shoulder flexion has significantly elevated from 4.167 ± 4.68 preoperative to be 59.58 ± 8.11 (P < 0.001). The mean value of shoulder abduction was increased significantly from 4.58 ± 4.50 preoperative to 65.41 ± 8.91 postoperative (P < 0.001). Moreover, the mean value of external rotation was improved significantly from 5.83 ± 5.15 preoperative to 65.42 ± 9.64 postoperative. Conclusion: That transferring spinal accessory nerve to the suprascapular nerve via the posterior approach for restoring shoulder abduction and external rotation is an effective and reliable treatment with high success rate in patients with brachial plexus palsy.