Iatrogenic Cervical Nerve Root Injury After Spine Surgery: How Nerve Surgeons Can Assist Spine Surgeons

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Figure 1
The most common nerve transfers that can be performed to treat patients with permanent upper limb palsy after cervical spine surgery. SAN, spinal accessory nerve; SSN, suprascapular nerve; ICN, intercostal nerve; MCN, musculocutaneous nerve; ECRB, extensor carpi radialis brevis branch of radial nerve; AIN, anterior interosseous nerve; FCR, flexor carpi radialis branch of median nerve; PIN, posterior interosseous nerve. Supinator, supinator branch of radial nerve. Brachialis nerve, a branch of the musculocutaneous nerve that innervates brachialis muscle.
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Figure 2
(a) Lateral neck x-ray images after anterior decompression for cervical disc herniation; (b) deltoid muscle atrophy after surgery.
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Figure 3
(a), (b) Preoperative examination showed loss of right elbow flexion after posterior laminectomy for the cervical spinal canal stenosis, (c) postoperative examination after double fascicular nerve transfer.

Table

Clinical findings and nerve transfers of the patients with iatrogenic cervical spine surgery.

Case	Age, y/Gender	Cause	Preoperative Loss of Function	Time From Injury to Surgery, mo	Surgery (Nerve Transfer)	Postoperative Muscle Force	Postoperative Follow-Up, mo
1	40/M	Anterior discectomy	Shoulder abduction after 30°	7	LHT to ant AxN	M4	9
2	36/F	Posterior laminectomy	Elbow flexion	9	Double fascicular nerve transfer	M4	7
3	28/M	Posterior laminectomy	Elbow flexion	9	Double fascicular nerve transfer	M4	12
4	42/M	Posterior laminectomy	Shoulder abduction and elbow flexion	12	Spinal accessory nerve to suprascapular nerve LHT to anterior AxN Double fascicular nerve transfer	M4	12

Abbreviations: Ant AxN, anterior branch of axillary nerve; LHT, long head of triceps branch of radial nerve.
Note: Double fascicular nerve transfer, an ulnar nerve fascicle to the biceps motor branch and a fascicle of median nerve to brachialis motor branch of musculocutaneous nerve.