P Texakalidis1, D Xenos2, N K Murthy1, C L Karras1, S J Trybula1, M Behbahani1, M G DeCuypere1, S K Lam1, T D Alden3. 1. Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Division of Neurosurgery, Ann & Robert H Lurie Children's Hospital of Chicago, IL, 60611, Chicago, USA. 2. Hippokrates General Hospital, Athens, Greece. 3. Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Division of Neurosurgery, Ann & Robert H Lurie Children's Hospital of Chicago, IL, 60611, Chicago, USA. talden@luriechildrens.org.
Abstract
BACKGROUND: Acute flaccid myelitis (AFM) is a rare disease that commonly affects young children. AFM's pathophysiology involves loss of lower motor neurons following a viral infection and induces acute asymmetric flaccid paralysis most commonly in the upper extremities. Nerve transfers have emerged as a treatment option for these patients with permanent motor deficits. OBJECTIVE: To summarize the literature and report safety and efficacy outcomes following nerve transfers for recovery of shoulder abduction and external rotation, and elbow flexion and extension in pediatric patients with AFM. Recovery of at least antigravity function was defined as a successful outcome. This systematic review was performed according to the PRISMA guidelines. The PubMed, Embase and Cochrane databases were utilized. RESULTS: Five studies comprising 44 patients (median age 2.95 years; 71% male), and 93 upper extremity nerve transfers were included. Thirty-eight patients received 65 nerve transfer procedures aiming for recovery of shoulder abduction and/or external rotation with a transfer to the axillary and/or suprascapular nerve. The recovery of shoulder abduction and external rotation was achieved in 40.7% (n = 11/27) and 60% (n = 6/10) of patients, respectively. Time from injury to surgery showed an inverse relationship with the odds for successful recovery (OR: 0.81; 95% CI: 0.64-1.02; p = 0.07); however, statistical significance was not reached. Successful recovery of elbow flexion with a transfer to the musculocutaneous was reported at a rate of 92.3% (n = 12/13). Successful re-innervation of the radial nerve with recovery of elbow extension was found in 75% (n = 6/8) of patients. No complications were reported. CONCLUSIONS: Upper extremity nerve transfers appear to be promising and safe for AFM patients. Shoulder abduction is the most challenging upper extremity function to recover. Further studies are warranted to identify whether nerve transfers are associated with superior outcomes when performed earlier.
BACKGROUND: Acute flaccid myelitis (AFM) is a rare disease that commonly affects young children. AFM's pathophysiology involves loss of lower motor neurons following a viral infection and induces acute asymmetric flaccid paralysis most commonly in the upper extremities. Nerve transfers have emerged as a treatment option for these patients with permanent motor deficits. OBJECTIVE: To summarize the literature and report safety and efficacy outcomes following nerve transfers for recovery of shoulder abduction and external rotation, and elbow flexion and extension in pediatric patients with AFM. Recovery of at least antigravity function was defined as a successful outcome. This systematic review was performed according to the PRISMA guidelines. The PubMed, Embase and Cochrane databases were utilized. RESULTS: Five studies comprising 44 patients (median age 2.95 years; 71% male), and 93 upper extremity nerve transfers were included. Thirty-eight patients received 65 nerve transfer procedures aiming for recovery of shoulder abduction and/or external rotation with a transfer to the axillary and/or suprascapular nerve. The recovery of shoulder abduction and external rotation was achieved in 40.7% (n = 11/27) and 60% (n = 6/10) of patients, respectively. Time from injury to surgery showed an inverse relationship with the odds for successful recovery (OR: 0.81; 95% CI: 0.64-1.02; p = 0.07); however, statistical significance was not reached. Successful recovery of elbow flexion with a transfer to the musculocutaneous was reported at a rate of 92.3% (n = 12/13). Successful re-innervation of the radial nerve with recovery of elbow extension was found in 75% (n = 6/8) of patients. No complications were reported. CONCLUSIONS: Upper extremity nerve transfers appear to be promising and safe for AFM patients. Shoulder abduction is the most challenging upper extremity function to recover. Further studies are warranted to identify whether nerve transfers are associated with superior outcomes when performed earlier.
Authors: Jan A Martin; Kevin Messacar; Michele L Yang; John A Maloney; Jennifer Lindwall; Terri Carry; Patricia Kenyon; Stefan H Sillau; Joyce Oleszek; Kenneth L Tyler; Samuel R Dominguez; Teri L Schreiner Journal: Neurology Date: 2017-06-14 Impact factor: 9.910
Authors: Keith Van Haren; Patrick Ayscue; Emmanuelle Waubant; Anna Clayton; Heather Sheriff; Shigeo Yagi; Rose Glenn-Finer; Tasha Padilla; Jonathan B Strober; Grace Aldrovandi; Debra A Wadford; Charles Y Chiu; Dongxiang Xia; Kathleen Harriman; James P Watt; Carol A Glaser Journal: JAMA Date: 2015 Dec 22-29 Impact factor: 56.272
Authors: Gary R Nelson; Joshua L Bonkowsky; Elizabeth Doll; Michael Green; Gary L Hedlund; Kevin R Moore; James F Bale Journal: Pediatr Neurol Date: 2015-10-20 Impact factor: 3.372
Authors: Taylor M Paziuk; Madeline Tadley; Michael Aversano; Scott H Kozin; Dan A Zlotolow Journal: Pediatr Neurol Date: 2020-07-08 Impact factor: 3.372
Authors: Rifali Patel; Grace Y Gombolay; Allan E Peljovich; Jessica Conklin; Laura S Blackwell; Robyn Howarth; David S Wolf; Saila R Upadhyayula; Sumit Verma Journal: J Child Neurol Date: 2020-07-17 Impact factor: 1.987
Authors: Kevin Messacar; Teri L Schreiner; Keith Van Haren; Michele Yang; Carol A Glaser; Kenneth L Tyler; Samuel R Dominguez Journal: Ann Neurol Date: 2016-08-04 Impact factor: 10.422
Authors: Jelte Helfferich; Marjolein Knoester; Coretta C Van Leer-Buter; Rinze F Neuteboom; Linda C Meiners; Hubert G Niesters; Oebele F Brouwer Journal: Eur J Pediatr Date: 2019-07-23 Impact factor: 3.183