A Modified Posterior Approach to the Nerve Transfer of the Spinal Accessory Nerve to the Suprascapular Nerve
Bibliographic record
Abstract
Purpose: Restoration of shoulder abduction and external rotation is critical in patients with upper brachial plexus injuries (BPIs). The transfer of the spinal accessory nerve to the suprascapular nerve is a well-established surgical technique; however, the optimal approach remains debated. The traditional posterior approach may compromise muscle integrity because of trapezius detachment and splitting of the supraspinatus. This study introduces a muscle-sparing modification to the posterior approach and evaluates functional outcomes in pediatric and adult patients with obstetric or traumatic BPIs. Methods: A retrospective review was conducted on patients who underwent spinal accessory nerve to suprascapular nerve transfer using a muscle-sparing posterior approach from September 2018 to November 2022. Inclusion criteria comprised pediatric patients (aged ≤18 months) with obstetric BPIs and adult patients with traumatic BPIs with a minimum postoperative follow-up of 24 months. Pediatric patients were evaluated using the Toronto Muscle Grading System, Modified Mallet Grading System, and Birch Triple System. Adults were assessed using range of motion and Disabilities of the Arm, Shoulder, and Hand questionnaire scores. Results: Fourteen patients met the inclusion criteria (six pediatric and eight adult). Pediatric outcomes demonstrated Modified Mallet Grading System scores of grade IV and Birch Triple System stages IV-V, indicating good shoulder function. Toronto Muscle Grading System scores of 3 reflected active movement against gravity. Among adults, mean forward flexion improved from 35° to 53°, abduction improved from 28° to 47°, and external rotation improved from 12° to 23°. The mean Disabilities of the Arm, Shoulder, and Hand questionnaire score improved from 91 to 48, exceeding the minimal clinically notable difference. No complications were observed. Conclusions: The muscle-sparing posterior approach for spinal accessory nerve to suprascapular nerve transfer is a safe and effective technique that yields favorable functional outcomes in both pediatric and adult BPI populations. Further comparative studies are warranted. Type of study/level of evidence: Therapeutic IV.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".