Neurosurgery. 2026 Apr 10. doi: 10.1227/neu.0000000000004030. Online ahead of print.
ABSTRACT
BACKGROUND AND OBJECTIVES: Early nerve reconstruction may improve arm recovery after neonatal brachial plexus palsy (NBPP), but the effect of nerve transfer vs graft repair with respect to surgical timing is not well understood.
METHODS: We retrospectively reviewed all NBPP patients who underwent nerve reconstruction at a single institution from 2005 to 2020. Patients were grouped by age at surgery (≤9 months vs >9 months) and by type of reconstruction (graft repair or nerve transfer). Upper extremity active range of motion measurements were collected at follow-up visits. Generalized estimating equations were used to predict differences in long-term outcomes for each arm movement between groups.
RESULTS: Ninety-nine children were included in the study. For shoulder reconstruction, 26 underwent early (≤9 months) and 5 underwent late (>9 months) graft repair while 30 underwent early and 13 underwent late nerve transfer. For elbow forearm reconstruction, 29 underwent early and 5 underwent late graft repair, while 44 underwent early and 20 underwent late nerve transfer. At the final follow-up, patients who underwent nerve transfer at ≤9 months only had significantly better elbow extension (0.85 vs 0.61, P = .028) compared with those who had surgery later. Children who had early graft repair had significantly better forward flexion (0.62 vs 0.29, P = .02), shoulder external rotation (0.76 vs 0.38, P < .001), forearm supination (0.73 vs 0.46, P < .001), and elbow extension (0.76 vs 0.40, P < .001) than those who had delayed graft repair.
CONCLUSION: Earlier surgery is associated with improved long-term active range of motion after NBPP regardless of nerve reconstruction type. However, there is significant improvement in more upper extremity movements in early vs late graft repair than early vs late transfer, suggesting that age of surgery is particularly important for successful nerve grafting.
PMID:41960916 | DOI:10.1227/neu.0000000000004030
