Spinal Accessory to Suprascapular Nerve Transfer for Restoration of Shoulder Function After Brachial Plexus Injury: Systematic Review and Meta-analysis | ||
| The Egyptian Orthopaedic Journal | ||
| Articles in Press, Accepted Manuscript, Available Online from 24 October 2025 | ||
| Document Type: Original Article | ||
| DOI: 10.21608/eoj.2025.419855.1078 | ||
| Authors | ||
| Aditya KS; Anil Regmi* ; Ramapriya Yasam; Varun Garg; Vikas Maheshwari; Vivek Singh | ||
| Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), Rishikesh, India | ||
| Abstract | ||
| Introduction Traumatic brachial plexus injury is a debilitating condition, most often due to high-energy motor vehicle accidents. Functional recovery focuses on restoring shoulder stability, abduction, and external rotation. The spinal accessory nerve to suprascapular nerve transfer has become the gold-standard reconstructive option due to its motor fiber predominance, axonal count, and anatomical proximity. However, the reported results remain inconsistent between anterior and dorsal approaches. Methods A systematic review and pooled analysis were conducted following PRISMA 2020 guidelines (PROSPERO: CRD420251166250). Searches of PubMed, Scopus, LILAC, and Cochrane databases identified studies reporting functional outcomes after SAN-to-SSN transfer in adult TBPI. Data on demographics, surgical technique, follow-up, and functional results were extracted. Quality was assessed using the MINORS tool. Studies reporting event counts were included in a random-effects proportion meta-analysis using the inverse variance method with Freeman-Tukey transformation. Results Sixteen studies (n = 629 patients) were included. The mean age was 29.3 years with male predominance. Most underwent the anterior approach, though five studies utilized the dorsal route. The pooled proportion achieving functional shoulder abduction (≥M3) was 0.49 (95% CI: 0.23–0.75; I² = 93%), and useful external rotation was 0.32 (95% CI: 0.13–0.55; I² = 88%). Early intervention and partial plexus injuries yielded superior outcomes. Conclusion SAN-to-SSN transfer achieves functional shoulder abduction in roughly half of TBPI cases and useful external rotation in one-third. Although the anterior approach is standard, the drosal route may preserve trapezius function and shorten reinnervation distance. High heterogeneity underscores the need for standardized reporting and prospective comparative studies. | ||
| Keywords | ||
| Brachial Plexus Injury; Nerve Transfer; Spinal Accessory Nerve; Suprascapular Nerve Transfer; Systematic Review | ||
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