{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T15:00:54Z","timestamp":1781190054285,"version":"3.54.1"},"reference-count":94,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","license":[{"start":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T00:00:00Z","timestamp":1771545600000},"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":[],"published-print":{"date-parts":[[2026,2,20]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>A key residual deficit in brachial plexus birth injury (BPBI) is the lack of active glenohumeral external rotation (ER). Surgical options for reinnervating the suprascapular nerve (SSN) include nerve grafting from a proximal stump and nerve transfer using the spinal accessory nerve (XIN) as a donor. The optimal surgical strategy is unclear from the current literature. This study aimed to compare the outcomes of nerve grafting and nerve transfer for SSN reinnervation in upper trunk BPBI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>The authors conducted a retrospective study (1990\u20132020) on prospectively collected data of children with a C5\u20136 or C5\u2013C6\u2013partial C7 BPBI who underwent SSN grafting or transfer, with a minimum follow-up of 2 years. Outcome was assessed in degrees of active ER and Mallet subscores for hand-to-mouth reach, hand-to-head reach, and ER. The frequency of secondary shoulder procedures (tendon transfer and\/or anterior release) in both groups was also analyzed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>The study included 245 patients with a mean follow-up of 7.6 \u00b1 4.3 years: 179 (73%) underwent C5-SSN grafting and 66 (27%) XIN-SSN transfer. The nerve transfer group demonstrated an active range of ER that was 30\u00b0 (95% CI 12\u00b0\u201349\u00b0, p = 0.002) larger than that of the nerve grafting group, adjusted for sex, birth weight, and diagnosis. At age 3 years, 33% of children achieved Mallet score IV ER after nerve transfer compared with 17% after nerve grafting (p = 0.002). Hand-to-mouth and hand-to-head scores were similar between the groups. The 10-year cumulative risk of subsequent shoulder procedures was 30% (95% CI 23%\u201337%) for nerve grafting and 24% (95% CI 13%\u201335%) for nerve transfer (nonsignificant).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>XIN-SSN transfer results in superior active ER compared to nerve grafting. Future studies should investigate whether the long-term impact of trapezius muscle loss is acceptable, to determine whether nerve transfer should be prioritized over grafting in the presence of a graftable C5 root.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.9.peds25338","type":"journal-article","created":{"date-parts":[[2026,2,21]],"date-time":"2026-02-21T02:34:21Z","timestamp":1771641261000},"page":"479-488","source":"Crossref","is-referenced-by-count":0,"title":["Active shoulder external rotation recovery in upper brachial plexus birth injury following nerve surgery: is spinal accessory nerve\u2013suprascapular nerve transfer superior to C5\u2013suprascapular nerve grafting?"],"prefix":"10.3171","volume":"37","author":[{"given":"Eva T. E.","family":"Ulmann","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martijn J. A.","family":"Malessy","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jochem","family":"Nagels","sequence":"additional","affiliation":[{"name":"Orthopedic Surgery, Leiden University Medical Center, Leiden, South Holland, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Willem","family":"Pondaag","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"6","key":"b1","series-title":"Dev Med Child Neurol","first-page":"673","article-title":"Risk factors for neonatal brachial plexus palsy: a systematic review and meta-analysis","volume":"62","author":"Van der Looven R","year":"2020","unstructured":"Van der Looven R, Le Roy L, Tanghe E,  Risk factors for neonatal brachial plexus palsy: a systematic review and meta-analysis. 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