Key result
Nerve transfer surgery in patients with acute flaccid myelitis resulted in 87% excellent recovery for elbow flexion and 90% resolution of shoulder pseudosubluxation.
Why the study?
Early functional outcomes of nerve transfer surgery in patients with acute flaccid myelitis needed to be described.
Does nerve transfer surgery improve motor function in patients with acute flaccid myelitis?
Observational (n=16)
Does nerve transfer surgery improve motor function in patients with acute flaccid myelitis?
Nerve transfer surgery provides reliable restoration of elbow function and resolution of shoulder pseudosubluxation in patients with acute flaccid myelitis and persistent motor deficits.
This is the authors' abstract. We don't add key points for this paper.
OBJECTIVE: To describe early functional outcomes of nerve transfer surgery in a relatively large cohort of patients with acute flaccid myelitis (AFM). METHODS: A retrospective case analysis was made of patients with AFM treated with nerve transfer surgery between 2007 and 2018. Surgical criteria were persistent motor deficits after 6 months from onset and available donor nerves. Thirty-two patients with AFM were evaluated; 16 underwent nerve transfer surgeries. Motor function was evaluated by a licensed occupational therapist using the Active Movement Scale preoperatively and during follow-up examinations. Patients with 6 or more months of follow-up were included in the analysis. Patients with procedures other than nerve transfers were excluded. RESULTS: Sixteen patients with AFM had nerve transfers, with a male predominance (75%) and median age of 2.5 years (range = 4 months-12 years). Eleven patients had a minimum 6 months of follow-up. Nerve transfers to restore elbow function had 87% excellent recovery for elbow flexion and 67% for elbow extension. Finger and thumb extension were full against gravity in 1 patient (100%). Shoulder external rotation was excellent in 50% of patients and shoulder abduction in only 20%. Nine of 10 patients (90%) had resolution of shoulder pseudosubluxation following nerve transfer to the suprascapular nerve. INTERPRETATION: Patients with AFM with persistent motor deficits 6 to 9 months after onset benefit from nerve transfer surgery. Restoration of elbow function was more reliable than restoration of shoulder function. We recommend early referral of patients with incomplete recovery to a center experienced in nerve transfers for timely evaluation and treatment. ANN NEUROL 2019;86:607-615.
Answers are grounded in this paper and cite their sources.
May support nerve transfer in select AFM cases; hypothesis-generating and requires randomized confirmation before practice change.
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Pino et al. (2019) conducted an observational in acute flaccid myelitis (n=16). Nerve transfer surgery was evaluated on excellent recovery for elbow flexion. Nerve transfer surgery in patients with acute flaccid myelitis resulted in 87% excellent recovery for elbow flexion and 90% resolution of shoulder pseudosubluxation.
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