2017 Loch-Wilkinson T, McNeil S, White C, Schrag C, Midha R
Nerve Transfers in Patients with Brown-Se´quard Pattern of Spinal Cord Injury. World Neurosurgery 2017 Nov 9.
Use of distal nerve transfer for improving upper limb function has been well described for patients with tetraplegic spinal cord injury and brachial plexus injuries but has not previously been described for Brown-Séquard type spinal cord injury. We describe our experience with 2 cases of combined Brown-Séquard injury and unilateral brachial amyotrophy.
Patient 1, a 43-year-old woman, was involved in a motor vehicle accident and sustained left-side C5-7 level hemicord injury causing ipsilateral proximal arm weakness and sensory loss with contralateral hemisensory changes, neuropathic pain, and spasms. At 6 months after injury, she underwent a spinal accessory to suprascapular nerve, radial nerve triceps branch to axillary nerve, and ulnar fascicle to biceps transfer. At 2-year followup, she had improved function with Medical Research Council grade 4 power of shoulder abduction, elbow flexion, and internal and external rotation.
Patient 2, a 38-year-old man, sustained a C4-5 fracture-dislocation in a motor vehicle accident and associated right-side hemicord injury involving the C5 and C6 myotomes with relatively preserved distal function. At 9 months after injury, he underwent radial nerve triceps branch to axillary nerve division and ulnar nerve fascicle to musculocutaneous nerve brachialis branch transfer. At 8 months after surgery, electromyography demonstrated evidence of further reinnervation of the deltoid muscle.
Our early experience of nerve transfer with 2 patients with combined Brown-Séquard cord injury and brachial amyotrophy indicated acceptable surgical safety and demonstrated encouraging results.