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Wu KY, Lee EY, Loosbrock MF, Bishop AT, Spinner RJ, Shin AY. Validation of the Root Analysis Score for C5 Viability in Patients With Pan-Brachial Plexus Injury. J Hand Surg Am 2024:S0363-5023(24)00029-7. [PMID: 38430093 DOI: 10.1016/j.jhsa.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 01/08/2024] [Accepted: 01/24/2024] [Indexed: 03/03/2024]
Abstract
PURPOSE Pan-brachial plexus injury patients present a reconstructive challenge. The root analysis score, developed from parsimonious multivariable modeling of 311 pan-brachial plexus injury patients, determines the probability of having a viable C5 nerve based on four categories: positive C5 Tinel test, intact C5 nerve on computed tomography myelogram, lack of hemidiaphragmatic elevation, and absence of midcervical paraspinal fibrillations. METHODS Root analysis scores were calculated for a separate cohort of patients with pan-brachial plexus injuries. Scores were validated by the presence or absence of a graftable C5 root, based on supraclavicular exploration and intraoperative electrophysiologic testing. Receiver operating characteristic curve, accuracy, and concordance statistic of the scores were calculated. Patients were divided into three root analysis score cohorts: less than 50 (low), 50-75 (average), and 75-100 points (high) based on dividing the score into quartiles and combining the lowest two. The probability, sensitivity, and specificity of each cohort having an available C5 nerve were based on the intraoperative assessment. RESULTS Eighty patients (mean age, 33.1 years; 15 women and 65 men) were included. Thirty-one patients (39%) had a viable C5 nerve. The root analysis calculator had an overall accuracy of 82.5%, a receiver operating characteristic of 0.87, and a concordance statistic of 0.87, demonstrating high overall predictive value; 6.5% of patients with a score of less than 50 (94% sensitivity and 43% specificity), 16.1% of patients with a score of 50-75 (94% sensitivity and 67% specificity), and 77.4% of patients with a score of 75-100 (77% sensitivity and 90% specificity) had a graftable C5 nerve. CONCLUSIONS The root analysis score demonstrated high accuracy and predictive power for a viable C5 nerve. In patients with a score of less than 50, the necessity of supraclavicular root exploration should balance patient factors, presentation timing, and concomitant injuries. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnosis II.
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Affiliation(s)
- Kitty Y Wu
- Division of Plastic Surgery, Mayo Clinic, Rochester, MN; Division of Hand and Microvascular Surgery, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Ellen Y Lee
- Department of Hand and Reconstructive Microsurgery, National University Health System, Singapore
| | - Michelle F Loosbrock
- Division of Hand and Microvascular Surgery, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Allen T Bishop
- Division of Hand and Microvascular Surgery, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Robert J Spinner
- Division of Hand and Microvascular Surgery, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN; Department of Neurosurgery, Mayo Clinic, Rochester, MN
| | - Alexander Y Shin
- Division of Hand and Microvascular Surgery, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.
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Rasulić L, Lepić M, Shlobin N, Samardžić M. A Brief History of Peripheral Nerve Surgery in Serbia. World Neurosurg 2023; 171:88-93. [PMID: 36435386 DOI: 10.1016/j.wneu.2022.11.086] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 11/18/2022] [Accepted: 11/19/2022] [Indexed: 11/25/2022]
Abstract
Peripheral nerve surgery in Serbia has become the most fruitful subsection of national neurosurgery, with international recognition of Serbian surgeons and institutions. We chronicle landmark events in the history of the field in Serbia, highlighting the development of the field over time and outlining future prospects. This manuscript provides an example of the development of peripheral nerve surgery and associated training in a challenging social, political, and economic context and may guide the development of peripheral nerve surgery care and training in other settings.
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Rasulić L, Socolovsky M, Heinen C, Demetriades A, Lepić M, Shlobin NA, Savić A, Grujić J, Mandić-Rajčević S, Lepić S, Samardžic M. Peripheral nerve surgery in Serbia: "Think global, act local" and the privilege of service. Brain Spine 2022; 2:101662. [PMID: 36506287 PMCID: PMC9729806 DOI: 10.1016/j.bas.2022.101662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 09/29/2022] [Accepted: 10/21/2022] [Indexed: 12/12/2022]
Abstract
Introduction The phrase "think globally, act locally", which has often been used to refer to conservation of the environment, highlights the importance of maintaining a holistic perspective and stipulates that each individual has a role to play in their community and larger world. Although peripheral nerve surgery has been largely unemphasized in global neurosurgical efforts, a wide disparity in peripheral nerve surgery is presumed to exist between high-income and low- and middle-income countries. Serbia is an upper middle-income country with a long history of peripheral nerve surgery. Research question How can understanding the development of peripheral nerve surgery in Serbia advance global education and improve peripheral nerve surgery worldwide? Material and methods An anecdotal and narrative review of recent advances in peripheral nerve surgery in Serbia was conducted. The World Federation of Neurosurgical Society (WFNS) Peripheral Nerve Surgery Committee discussions on improving peripheral nerve surgery education were summarized. Results In this manuscript, we describe the application of "think globally, act locally" to peripheral nerve surgery by providing an account of the development of peripheral nerve surgery in Serbia. Then, we report measures taken by the WFNS Peripheral Nerve Surgery Committee to improve education on peripheral nerve surgery in LMICs. Discussion and conclusion Viewing the development of peripheral nerve surgery in Serbia through the lens of "think globally, act locally" may guide the development of peripheral nerve surgery in LMICs.
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Affiliation(s)
- Lukas Rasulić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia,Department of Peripheral Nerve Surgery, Functional Neurosurgery and Pain Management Surgery, Clinic for Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia,Corresponding author. Department of Peripheral Nerve Surgery, Functional Neurosurgery and Pain Management Surgery, Clinic for Neurosurgery, Clinical Center of Serbia, Višegradska 26, Belgrade, Serbia.
| | - Mariano Socolovsky
- Peripheral Nerve and Plexus Program, Department of Neurosurgery, University of Buenos Aires School of Medicine, Buenos Aires, Argentina
| | - Christian Heinen
- Peripheral Nerve Unit Nord, Christliches Krankenhaus Quakenbrück GmbH, Quakenbrück, Germany
| | - Andreas Demetriades
- Department of Neurosurgery, Royal Infirmary of Edinburgh, Little France, Edinburgh, UK
| | - Milan Lepić
- Department of Neurosurgery, Military Medical Academy, Belgrade, Serbia
| | - Nathan A. Shlobin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Andrija Savić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia,Department of Peripheral Nerve Surgery, Functional Neurosurgery and Pain Management Surgery, Clinic for Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Jovan Grujić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia,Department of Peripheral Nerve Surgery, Functional Neurosurgery and Pain Management Surgery, Clinic for Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Stefan Mandić-Rajčević
- School of Public Health and Health Management and Institute of Social Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Sanja Lepić
- Institute of Hygiene, Military Medical Academy, Belgrade, Serbia
| | - Miroslav Samardžic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia,Department of Peripheral Nerve Surgery, Functional Neurosurgery and Pain Management Surgery, Clinic for Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia
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Rasulić L, Lepić M, Samardžić M. Commentary: Nerve Graft Length and Recovery of Elbow Flexion Muscle Strength in Patients With Traumatic Brachial Plexus Injuries: Case Series. Oper Neurosurg (Hagerstown) 2021; 21:E165-E166. [PMID: 34097737 DOI: 10.1093/ons/opab177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 04/04/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Lukas Rasulić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Department of Peripheral Nerve Surgery, Functional Neurosurgery and Pain Management Surgery, Clinic for Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Milan Lepić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Clinic for Neurosurgery, Military Medical Academy, Belgrade, Serbia
| | - Miroslav Samardžić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Department of Peripheral Nerve Surgery, Functional Neurosurgery and Pain Management Surgery, Clinic for Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia
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Wells ME, Gonzalez GA, Childs BR, Williams MR, Nesti LJ, Dunn JC. Radial to Axillary Nerve Transfer Outcomes in Shoulder Abduction: A Systematic Review. Plast Reconstr Surg Glob Open 2020; 8:e3096. [PMID: 33133948 DOI: 10.1097/GOX.0000000000003096] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 07/17/2020] [Indexed: 12/17/2022]
Abstract
Background Brachial plexus and axillary nerve injuries often result in paralysis of the deltoid muscle. This can be functionally debilitating for patients and have a negative impact on their activities of daily living. In these settings, transferring the branch of the radial nerve innervating the triceps to the axillary nerve is a viable treatment option. Additional nerve transfers may be warranted. This study sought to determine the efficacy of nerve transfer procedures in the setting of brachial plexus and axillary nerve injuries and factors affecting clinical outcomes. Methods The U.S. National Library of Medicine's website "PubMed" was queried for "radial to axillary nerve transfer" and "brachial plexus nerve transfer." An initial review by two authors was performed to identify relevant articles followed by a third author validation utilizing inclusion and exclusion criteria. Individual patient outcomes were recorded and pooled for final analysis. Results Of the 80 patients, 66 (82.5%) had clinical improvement after surgical nerve transfer procedures. Significant difference in clinical improvement following nerve transfer procedures was correlated with patient age, mechanism of injury, brachial plexus vs isolated axillary nerve injuries, multiple nerve transfers vs single nerve transfers, and surgery within the first 7 months of injury. The branch of the radial nerve supplying the triceps long head showed improved clinical results compared with the branch of the radial nerve supplying the triceps medial head and anconeus. Conclusion Nerve transfers have been shown to be effective in restoring shoulder abduction in both isolated axillary nerve injuries and brachial plexus injuries.
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Hsueh YH, Tu YK. Surgical reconstructions for adult brachial plexus injuries. Part I: Treatments for combined C5 and C6 injuries, with or without C7 injuries. Injury 2020; 51:787-803. [PMID: 32156416 DOI: 10.1016/j.injury.2020.02.076] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 02/15/2020] [Indexed: 02/02/2023]
Abstract
Brachial plexus injuries will cause a significantly decreased quality of life. Patients with upper arm type brachial plexus injuries, which means C5 and C6 roots injury, will lose their shoulder elevation/abduction/external rotation, and elbow flexion function. Additional elbow, wrist, and hand extension function deficit will occur in patients with C7 root injury. With the advances of reconstructive procedures, the upper arm brachial plexus injuries can be successfully restored through nerve repair, nerve grafting, nerve transfer, muscle / tendon transfer and free functioning muscle transfer. In this review article, we summarized the various reconstructive procedures to restore the function of shoulder and elbow. Nowadays, the upper arm type BPI can be treat with satisfied outcomes (80-90% successful rate).
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Alzahrani S, Midha R. Commentary: Viable C5 and C6 Proximal Stumps Use in Reconstructive Surgery of the Adult Brachial Plexus Traction Injuries. Neurosurgery 2020; 86:E260-E262. [PMID: 31237337 DOI: 10.1093/neuros/nyz215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 03/08/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
- Saud Alzahrani
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Rajiv Midha
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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