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Contralateral cervical seventh nerve transfer for spastic arm paralysis via a modified prespinal route: a cadaveric study

  • PeiYang Li
  • Yundong Shen
  • Jing Xu
  • Chunmin Liang
  • Su Jiang
  • Yanqun Qiu
  • Huawei Yin
  • Juntao Feng
  • Tie Li
  • Jun Shen
  • Guobao Wang
  • Baofu Yu
  • Xuan Ye
  • Aiping Yu
  • Gaowei Lei
  • Zeyu Cai
  • Wendong XuEmail author
Original Article - Neurosurgical Anatomy
  • 43 Downloads
Part of the following topical collections:
  1. Neurosurgical anatomy

Abstract

Background

We proposed contralateral cervical seventh nerve transfer for spastic arm paralysis after central neurological injury in the New England Journal of Medicine (NEJM) in 2018. In this surgery, we applied a new surgical route for nerve transfer, the Huashan prespinal route. The objective of this study was to elaborate our new surgical technique, clarify its relationship to the vertebral artery, and provide anatomical data on this novel method.

Methods

The effectiveness and safety of the Huashan prespinal route in contralateral C7 nerve transfer were evaluated anatomically. Nine cadavers (4 males, 5 females) were available for this study. Among these, anatomical parameters of the vertebral artery were obtained from 6 cadavers, and the anastomosis of the bilateral cervical seventh nerve was observed on 3 cadavers undergoing contralateral C7 nerve transfer via the Huashan prespinal route.

Results

Tension-free anastomosis of the bilateral cervical seventh nerve was achieved through the Huashan prespinal route. The tilt angle of the vertebral artery to the sagittal plane (with thyroid cartilage as the origin) was 25.5 ± 4.5°, at 22.5 ± 1.6° and 28.7 ± 4.3° on the left and right side, respectively. The safe drilling angle to penetrate through the longus colli muscles for the creation of a longus colli muscle tunnel to avoid injury to the vertebral artery in our surgical technique was above 33.2°.

Conclusions

The cadaveric study confirms that the presented technique allowed simple, effective, and safe contralateral C7 nerve transfer. This technique can be used in the treatment of hemiplegia and brachial plexus injury. There is a safe scope of drilling angle for creating the longus colli muscle tunnel required for this surgical route. The anatomical parameters obtained in this study will be helpful for the performance of this operation.

Keywords

Prespinal route Contralateral cervical seventh nerve transfer Spastic arm paralysis Central neurological injury 

Abbreviations

C7

Cervical seventh nerve

SCN

Sternocleidomastoid muscle

Notes

Funding information

This study was supported by grants from the National Key R&D Program of China (2017YFC0840100 and 2017YFC0840106), Distinguished Young Scientists (81525009), Key Program of National Science Foundation of China (81830063), Priority among Priorities of Shanghai Municipal Clinical Medicine Center (2017ZZ01006), Technology Innovation Program of Shanghai Science, and Technology Committee (18411950100).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

For this type of study, formal consent is not required.

Informed consent

This article does not contain any studies with human participants performed by any of the authors.

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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  • PeiYang Li
    • 1
  • Yundong Shen
    • 1
  • Jing Xu
    • 1
  • Chunmin Liang
    • 2
  • Su Jiang
    • 1
  • Yanqun Qiu
    • 3
  • Huawei Yin
    • 1
  • Juntao Feng
    • 1
  • Tie Li
    • 1
  • Jun Shen
    • 1
  • Guobao Wang
    • 1
  • Baofu Yu
    • 1
  • Xuan Ye
    • 1
  • Aiping Yu
    • 1
  • Gaowei Lei
    • 1
  • Zeyu Cai
    • 1
  • Wendong Xu
    • 1
    • 3
    • 4
    • 5
    • 6
    Email author
  1. 1.Department of Hand Surgery, Huashan Hospital, Shanghai Medical CollegeFudan UniversityShanghaiChina
  2. 2.Department of Anatomy, Histology & Embryology, Shanghai Medical CollegeFudan UniversityShanghaiChina
  3. 3.Department of Hand and Upper Extremity SurgeryJing’an District Central HospitalShanghaiChina
  4. 4.State Key Laboratory of Medical Neurobiology, Collaborative Innovation Center of Brain ScienceFudan UniversityShanghaiChina
  5. 5.Priority Among Priorities of Shanghai Municipal Clinical Medicine CenterShanghaiChina
  6. 6.National Clinical Research Center for Aging and Medicine, Huashan HospitalFudan UniversityShanghaiChina

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