{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T17:15:52Z","timestamp":1789924552263,"version":"4.0.1"},"reference-count":20,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,7]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>Spinal accessory nerve palsy is frequently caused by iatrogenic damage during neck surgery in the posterior triangle of the neck. Due to late presentation, treatment regularly necessitates nerve grafts, which often results in a poor outcome of trapezius function due to long regeneration distances. Here, the authors report a distal nerve transfer using fascicles of the upper trunk related to axillary nerve function for reinnervation of the trapezius muscle.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>Five cases are presented in which accessory nerve lesions were reconstructed using selective fascicular nerve transfers from the upper trunk of the brachial plexus. Outcomes were assessed at 20 \u00b1 6 months (mean \u00b1 SD) after surgery, and active range of motion and pain levels using the visual analog scale were documented.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>All 5 patients regained good to excellent trapezius function (3 patients had grade M5, 2 patients had grade M4). The mean active range of motion in shoulder abduction improved from 55\u00b0 \u00b1 18\u00b0 before to 151\u00b0 \u00b1 37\u00b0 after nerve reconstruction. In all patients, unrestricted shoulder arm movement was restored with loss of scapular winging when abducting the arm. Average pain levels decreased from 6.8 to 0.8 on the visual analog scale and subsided in 4 of 5 patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>Restoration of spinal accessory nerve function with selective fascicle transfers related to axillary nerve function from the upper trunk of the brachial plexus is a good and intuitive option for patients who do not qualify for primary nerve repair or present with a spontaneous idiopathic palsy. This concept circumvents the problem of long regeneration distances with direct nerve repair and has the advantage of cognitive synergy to the target function of shoulder movement.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2018.12.spine18498","type":"journal-article","created":{"date-parts":[[2019,4,9]],"date-time":"2019-04-09T20:03:12Z","timestamp":1554840192000},"page":"133-138","source":"Crossref","is-referenced-by-count":18,"title":["Reconstruction of the spinal accessory nerve with selective fascicular nerve transfer of the upper trunk"],"prefix":"10.3171","volume":"31","author":[{"given":"Johannes A.","family":"Mayer","sequence":"first","affiliation":[{"name":"Christian Doppler Laboratory for Restoration of Extremity Function, Department of Surgery, Medical University of Vienna;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura A.","family":"Hruby","sequence":"additional","affiliation":[{"name":"Christian Doppler Laboratory for Restoration of Extremity Function, Department of Surgery, Medical University of Vienna;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Salminger","sequence":"additional","affiliation":[{"name":"Christian Doppler Laboratory for Restoration of Extremity Function, Department of Surgery, Medical University of Vienna;"},{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerd","family":"Bodner","sequence":"additional","affiliation":[{"name":"Private Ultrasound Center Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oskar C.","family":"Aszmann","sequence":"additional","affiliation":[{"name":"Christian Doppler Laboratory for Restoration of Extremity Function, Department of Surgery, Medical University of Vienna;"},{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Neurosurg Clin N Am","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1016\/j.nec.2008.07.018","article-title":"Nerve transfers for severe nerve injury","volume":"20","author":"Addas BMJ","unstructured":"Addas BMJ, Midha R: Nerve transfers for severe nerve injury. Neurosurg Clin N Am 20:27\u201338, vi, 20091906417710.1016\/j.nec.2008.07.018"},{"key":"b2","series-title":"J Hand Surg Am","doi-asserted-by":"publisher","first-page":"1401","DOI":"10.1016\/j.jhsa.2006.04.014","article-title":"Refinements in the technique for repair of the accessory nerve","volume":"31","author":"Bertelli JA","year":"2006","unstructured":"Bertelli JA, Ghizoni MF: Refinements in the technique for repair of the accessory nerve. J Hand Surg Am 31:1401\u20131406, 20061702780610.1016\/j.jhsa.2006.04.014"},{"key":"b3","series-title":"J Ultrasound Med","doi-asserted-by":"publisher","first-page":"1159","DOI":"10.7863\/jum.2002.21.10.1159","article-title":"Ultrasonography of the accessory nerve: normal and pathologic findings in cadavers and patients with iatrogenic accessory nerve palsy","volume":"21","author":"Bodner G","year":"2002","unstructured":"Bodner G, Harpf C, Gardetto A, Kovacs P, Gruber H, Peer S, : Ultrasonography of the accessory nerve: normal and pathologic findings in cadavers and patients with iatrogenic accessory nerve palsy. J Ultrasound Med 21:1159\u20131163, 200210.7863\/jum.2002.21.10.115912369671"},{"key":"b4","series-title":"Scand J Plast Reconstr Surg Hand Surg","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1080\/02844310600836810","article-title":"Iatrogenic injury to the accessory nerve","volume":"41","author":"Bostr\u00f6m D","year":"2007","unstructured":"Bostr\u00f6m D, Dahlin LB: Iatrogenic injury to the accessory nerve. Scand J Plast Reconstr Surg Hand Surg 41:82\u201387, 200710.1080\/02844310600836810"},{"key":"b5","series-title":"J Hand Surg Eur","doi-asserted-by":"publisher","first-page":"589","DOI":"10.1177\/1753193418755618","article-title":"Spinal accessory nerve repair using a direct nerve transfer from the upper trunk: results with 2 years follow-up","volume":"43","author":"Cambon-Binder A","year":"2018","unstructured":"Cambon-Binder A, Preure L, Dubert-Khalifa H, Marcheix PS, Belkheyar Z: Spinal accessory nerve repair using a direct nerve transfer from the upper trunk: results with 2 years follow-up. J Hand Surg Eur Vol 43:589\u2013595, 201810.1177\/1753193418755618"},{"key":"b6","series-title":"Arch Neurol","doi-asserted-by":"publisher","first-page":"496","DOI":"10.1001\/archneur.1972.00490180032008","article-title":"Isolated accessory nerve palsy of spontaneous origin. A clinical and electromyographic study","volume":"27","author":"Eisen A","year":"1972","unstructured":"Eisen A, Bertrand G: Isolated accessory nerve palsy of spontaneous origin. A clinical and electromyographic study. Arch Neurol 27:496\u2013502, 1972508386710.1001\/archneur.1972.00490180032008"},{"key":"b7","series-title":"J Shoulder Elbow Surg","doi-asserted-by":"publisher","first-page":"1307","DOI":"10.1016\/j.jse.2015.01.008","article-title":"Outcome of triple-tendon transfer, an Eden-Lange variant, to reconstruct trapezius paralysis","volume":"24","author":"Elhassan BT","year":"2015","unstructured":"Elhassan BT, Wagner ER: Outcome of triple-tendon transfer, an Eden-Lange variant, to reconstruct trapezius paralysis. J Shoulder Elbow Surg 24:1307\u20131313, 201510.1016\/j.jse.2015.01.00825842024"},{"key":"b8","series-title":"SAGE Open Med","doi-asserted-by":"publisher","first-page":"2050312116645731","DOI":"10.1177\/2050312116645731","article-title":"Patient outcome after surgical management of the spinal accessory nerve injury: a long-term follow-up study","volume":"4","author":"G\u00f6ransson H","year":"2016","unstructured":"G\u00f6ransson H, Lepp\u00e4nen OV, Vastam\u00e4ki M: Patient outcome after surgical management of the spinal accessory nerve injury: a long-term follow-up study. SAGE Open Med 4:2050312116645731, 201610.1177\/205031211664573127152195"},{"key":"b9","series-title":"J Hand Surg Am","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1016\/j.jhsa.2006.11.008","article-title":"Use of the Medical Research Council muscle strength grading system in the upper extremity","volume":"32","author":"James MA","year":"2007","unstructured":"James MA: Use of the Medical Research Council muscle strength grading system in the upper extremity. J Hand Surg Am 32:154\u2013156, 200710.1016\/j.jhsa.2006.11.00817275587"},{"key":"b10","series-title":"South Med J","doi-asserted-by":"publisher","first-page":"1005","DOI":"10.1097\/00007611-197908000-00032","article-title":"Isolated accessory nerve palsy","volume":"72","author":"Laha RK","year":"1979","unstructured":"Laha RK, Panchal P: Isolated accessory nerve palsy. South Med J 72:1005\u20131007, 197910.1097\/00007611-197908000-00032224509"},{"key":"b11","series-title":"J Laryngol Otol","doi-asserted-by":"publisher","first-page":"1118","DOI":"10.1017\/S0022215107000461","article-title":"Accessory nerve: anatomy and surgical identification","volume":"121","author":"Lloyd S","year":"2007","unstructured":"Lloyd S: Accessory nerve: anatomy and surgical identification. J Laryngol Otol 121:1118\u20131125, 200710.1017\/S002221510700046117892604"},{"key":"b12","series-title":"J Reconstr Microsurg","doi-asserted-by":"publisher","first-page":"379","DOI":"10.1055\/s-2007-1006722","article-title":"A technique for the treatment of neuroma in-continuity","volume":"8","author":"Mackinnon SE","year":"1992","unstructured":"Mackinnon SE, Glickman LT, Dagum A: A technique for the treatment of neuroma in-continuity. J Reconstr Microsurg 8:379\u2013383, 1992140406710.1055\/s-2007-1006722"},{"key":"b13","series-title":"Otolaryngol Head Neck Surg","doi-asserted-by":"publisher","first-page":"854","DOI":"10.1016\/j.otohns.2008.09.006","article-title":"Same modality nerve reconstruction for accessory nerve injuries","volume":"139","author":"Magill CK","year":"2008","unstructured":"Magill CK, Moore AM, Mackinnon SE: Same modality nerve reconstruction for accessory nerve injuries. Otolaryngol Head Neck Surg 139:854\u2013856, 20081904151610.1016\/j.otohns.2008.09.006"},{"key":"b14","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"112","DOI":"10.3171\/2016.5.SPINE151458","article-title":"Lateral pectoral nerve transfer for spinal accessory nerve injury","volume":"26","author":"Maldonado AA","year":"2017","unstructured":"Maldonado AA, Spinner RJ: Lateral pectoral nerve transfer for spinal accessory nerve injury. J Neurosurg Spine 26:112\u2013115, 20172747274610.3171\/2016.5.SPINE151458"},{"key":"b15","series-title":"Hand Clin","doi-asserted-by":"publisher","first-page":"417","DOI":"10.1016\/j.hcl.2008.06.001","article-title":"Rehabilitation following motor nerve transfers","volume":"24","author":"Novak CB","unstructured":"Novak CB: Rehabilitation following motor nerve transfers. Hand Clin 24:417\u2013423, vi, 200810.1016\/j.hcl.2008.06.00118928890"},{"key":"b16","series-title":"Laryngoscope","doi-asserted-by":"publisher","first-page":"1482","DOI":"10.1097\/00005537-200408000-00030","article-title":"Treatment of a proximal accessory nerve injury with nerve transfer","volume":"114","author":"Novak CB","year":"2004","unstructured":"Novak CB, Mackinnon SE: Treatment of a proximal accessory nerve injury with nerve transfer. Laryngoscope 114:1482\u20131484, 20041528073010.1097\/00005537-200408000-00030"},{"key":"b17","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"518","DOI":"10.3171\/2014.12.SPINE14968","article-title":"Surgical outcomes of 156 spinal accessory nerve injuries caused by lymph node biopsy procedures","volume":"23","author":"Park SH","year":"2015","unstructured":"Park SH, Esquenazi Y, Kline DG, Kim DH: Surgical outcomes of 156 spinal accessory nerve injuries caused by lymph node biopsy procedures. J Neurosurg Spine 23:518\u2013525, 20152611502310.3171\/2014.12.SPINE14968"},{"key":"b18","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"1520","DOI":"10.3171\/2011.1.JNS10810","article-title":"Double fascicular nerve transfer to the biceps and brachialis muscles after brachial plexus injury: clinical outcomes in a series of 29 cases","volume":"114","author":"Ray WZ","year":"2011","unstructured":"Ray WZ, Pet MA, Yee A, Mackinnon SE: Double fascicular nerve transfer to the biceps and brachialis muscles after brachial plexus injury: clinical outcomes in a series of 29 cases. J Neurosurg 114:1520\u20131528, 201110.3171\/2011.1.JNS10810"},{"key":"b19","series-title":"Orthop Traumatol Surg Res","doi-asserted-by":"publisher","first-page":"589","DOI":"10.1016\/j.otsr.2010.03.017","article-title":"Idiopathic spinal accessory nerve palsy. A case report","volume":"96","author":"Sergides NN","year":"2010","unstructured":"Sergides NN, Nikolopoulos DD, Polyzois IG: Idiopathic spinal accessory nerve palsy. A case report. Orthop Traumatol Surg Res 96:589\u2013592, 201010.1016\/j.otsr.2010.03.01720580628"},{"key":"b20","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"555","DOI":"10.3171\/2017.8.SPINE17582","article-title":"Nerve fascicle transfer using a part of the C-7 nerve for spinal accessory nerve injury","volume":"28","author":"Ye X","year":"2018","unstructured":"Ye X, Shen YD, Feng JT, Xu WD: Nerve fascicle transfer using a part of the C-7 nerve for spinal accessory nerve injury. J Neurosurg Spine 28:555\u2013561, 201810.3171\/2017.8.SPINE1758229424673"}],"container-title":["Journal of Neurosurgery: Spine"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/31\/1\/article-p133.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/31\/1\/article-p133.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/31\/1\/article-p133.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,15]],"date-time":"2023-04-15T22:44:04Z","timestamp":1681598644000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/31\/1\/article-p133.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,7]]},"references-count":20,"journal-issue":{"issue":"1"},"URL":"https:\/\/doi.org\/10.3171\/2018.12.spine18498","relation":{},"ISSN":["1547-5654"],"issn-type":[{"value":"1547-5654","type":"print"}],"subject":[],"published":{"date-parts":[[2019,7]]}}}