{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:37:56Z","timestamp":1787755076427,"version":"build-2784847793"},"reference-count":18,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2019,1,1]],"date-time":"2019-01-01T00:00:00Z","timestamp":1546300800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JBJS OA"],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Acute flaccid myelitis (AFM) is a debilitating illness that is defined by the sudden onset of flaccid paralysis in the extremities with spinal magnetic resonance imaging (MRI) demonstrating a longitudinal lesion confined to the gray matter. The purpose of this study was to report the types of upper-extremity palsy and outcomes of surgical reconstruction in patients with AFM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Eight patients with a median age at onset of 3.8 years (range, 2.3 to 9.9 years) were identified. There was loss of shoulder abduction and external rotation in all patients, loss of elbow flexion in 5 patients, complete or partial loss of hand function in 3 patients, and spinal accessory nerve palsy in 2 patients. All patients underwent surgical reconstruction, which was categorized into 3 main groups: nerve transfer, secondary muscle transfer, and free muscle transfer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The median follow-up period was 39 months (range, 30 to 94 months). Four patients obtained \u226590\u00b0 of shoulder abduction whereas the other 4 patients had shoulder abduction of \u226470\u00b0. The 5 patients who received free muscle transfer or nerve transfer to restore elbow function obtained \u2265140\u00b0 of elbow flexion. Two patients treated with free muscle transfer to restore finger function obtained satisfactory total active motion of the fingers (180\u00b0).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>The patterns of paralysis and the strategy and outcomes of surgical reconstruction for patients with AFM differed from those for traumatic and obstetric brachial plexus palsy. All patients had loss of shoulder abduction, and 2 had spinal accessory nerve palsy. Restoration of shoulder function was unpredictable and depended on the quality of the donor nerves and recovery of synergistic muscles. Restoration of elbow and hand function was more consistent and satisfactory.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Therapeutic\n                      <jats:underline>Level IV<\/jats:underline>\n                      . See Instructions for Authors for a complete list of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.oa.19.00030","type":"journal-article","created":{"date-parts":[[2019,10,25]],"date-time":"2019-10-25T01:01:17Z","timestamp":1571965277000},"page":"e0030","source":"Crossref","is-referenced-by-count":14,"title":["Surgical Reconstruction for Upper-Extremity Paralysis Following Acute Flaccid Myelitis"],"prefix":"10.2106","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7162-2737","authenticated-orcid":false,"given":"Kazuteru","family":"Doi","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Yamaguchi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6962-2113","authenticated-orcid":false,"given":"Sei Haw","family":"Sem","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Yamaguchi, Japan"},{"name":"Department of Orthopaedics, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8053-2562","authenticated-orcid":false,"given":"Yasunori","family":"Hattori","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Yamaguchi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0136-5282","authenticated-orcid":false,"given":"Sotetsu","family":"Sakamoto","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Yamaguchi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2543-7797","authenticated-orcid":false,"given":"Kota","family":"Hayashi","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Yamaguchi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9368-3757","authenticated-orcid":false,"given":"Maria Angeles","family":"De la Red-Gallego","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Yamaguchi, Japan"},{"name":"Hospital Universitario Marques de Valdecilla, Santander, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2019]]},"reference":[{"issue":"12","key":"R1-20231211","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1007\/s11940-017-0480-3","article-title":"Acute flaccid myelitis: etiologic challenges, diagnostic and management considerations","volume":"19","author":"Hopkins","year":"2017","journal-title":"Curr Treat Options Neurol"},{"issue":"24","key":"R3-20231211","doi-asserted-by":"crossref","first-page":"2663","DOI":"10.1001\/jama.2015.17275","article-title":"Acute flaccid myelitis of unknown etiology in California, 2012\u20132015","volume":"314","author":"Van Haren","year":"2015","journal-title":"JAMA"},{"issue":"9978","key":"R4-20231211","doi-asserted-by":"crossref","first-page":"1662","DOI":"10.1016\/S0140-6736(14)62457-0","article-title":"A cluster of acute flaccid paralysis and cranial nerve dysfunction temporally associated with an outbreak of enterovirus D68 in children in Colorado, USA","volume":"385","author":"Messacar","year":"2015","journal-title":"Lancet"},{"issue":"6","key":"R5-20231211","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1093\/cid\/ciw372","article-title":"Acute flaccid myelitis in the United States, August-December 2014: results of nation-wide surveillance","volume":"63","author":"Sejvar","year":"2016","journal-title":"Clin Infect Dis"},{"key":"R6-20231211","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.pediatrneurol.2015.10.007","article-title":"Recognition and management of acute flaccid myelitis in children","volume":"55","author":"Nelson","year":"2016","journal-title":"Pediatr Neurol"},{"issue":"5","key":"R7-20231211","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1093\/cid\/cix860","article-title":"Acute Flaccid Myelitis Collaborative Study Investigators. 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