{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T17:13:49Z","timestamp":1789924429504,"version":"4.0.1"},"reference-count":26,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"9","license":[{"start":{"date-parts":[[2023,8,28]],"date-time":"2023-08-28T00:00:00Z","timestamp":1693180800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,8,28]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Spinal accessory nerve palsy can lead to severe shoulder pain and weakness, lateral scapular winging, and limitations in overhead activity. It most often occurs because of iatrogenic injury from procedures within the posterior triangle of the neck.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>The authors present the case of a 39-year-old male with symptoms of right shoulder weakness and neck pain after a total thyroidectomy and right neck dissection. With ultrasound findings of a neuroma-in-continuity but no clinical or electromyographic signs of reinnervation at 6 months, surgical intervention was indicated. Operative exploration confirmed a very proximal injury and nonconducting neuroma-in-continuity of the spinal accessory nerve. A selective distal nerve transfer from the posterior division of the upper trunk was performed. At the 2.5-year follow-up, the patient demonstrated excellent recovery of full active shoulder abduction and forward flexion, return to full-time employment, and mild residual scapular winging.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>Distal nerve transfers should be considered in cases of late presentation when primary repair is not possible or long interpositional grafts are required. Selective fascicular transfer from the posterior division of the upper trunk provides the advantages of a single incision, short reinnervation time, and synergistic donor function to facilitate motor reeducation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case23348","type":"journal-article","created":{"date-parts":[[2023,8,28]],"date-time":"2023-08-28T20:18:15Z","timestamp":1693253895000},"source":"Crossref","is-referenced-by-count":4,"title":["Selective upper trunk posterior division fascicular nerve transfer for proximal spinal accessory neuropathy: illustrative case"],"prefix":"10.3171","volume":"6","author":[{"given":"Kitty Y","family":"Wu","sequence":"first","affiliation":[{"name":"Division of Plastic Surgery, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert J","family":"Spinner","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"4","key":"b1","series-title":"J Back Musculoskeletal Rehabil","first-page":"899","article-title":"Spinal accessory nerve injury: A potentially missed cause of a painful, droopy shoulder","volume":"29","author":"Macaluso S","year":"2016","unstructured":"Macaluso S, Ross DC, Doherty TJ, Doherty CD, Miller TA. Spinal accessory nerve injury: A potentially missed cause of a painful, droopy shoulder. J Back Musculoskeletal Rehabil. 2016;29(4):899\u2013904."},{"issue":"3","key":"b2","series-title":"Can J Neurol Sci","first-page":"337","article-title":"Accessory nerve palsy: a review of 23 cases","volume":"18","author":"Berry H","year":"1991","unstructured":"Berry H, MacDonald EA, Mrazek AC. Accessory nerve palsy: a review of 23 cases. Can J Neurol Sci. 1991;18(3):337\u2013341."},{"issue":"16","key":"b3","series-title":"Dtsch Arztebl Int","first-page":"273","article-title":"Iatrogenic nerve injuries: prevalence, diagnosis and treatment","volume":"111","author":"Antoniadis G","year":"2014","unstructured":"Antoniadis G, Kretschmer T, Pedro MT, K\u00f6nig RW, Heinen CP, Richter HP. Iatrogenic nerve injuries: prevalence, diagnosis and treatment. Dtsch Arztebl Int. 2014;111(16):273\u2013279."},{"issue":"6","key":"b4","series-title":"J Hand Surg Eur Vol","first-page":"589","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. 2018;43(6):589\u2013595."},{"issue":"1","key":"b5","series-title":"J Neurosurg Spine","first-page":"133","article-title":"Reconstruction of the spinal accessory nerve with selective fascicular nerve transfer of the upper trunk","volume":"31","author":"Mayer JA","year":"2019","unstructured":"Mayer JA, Hruby LA, Salminger S, Bodner G, Aszmann OC. Reconstruction of the spinal accessory nerve with selective fascicular nerve transfer of the upper trunk. J Neurosurg Spine. 2019;31(1):133\u2013138."},{"issue":"5","key":"b6","series-title":"J Neurosurg Case Lessons","first-page":"CASE21609","article-title":"Transfer of the anterior C3 levator scapulae motor nerve branch for spinal accessory nerve injury: illustrative case","volume":"3","author":"Gatskiy AA","year":"2022","unstructured":"Gatskiy AA, Tretyak IB, Tsymbaliuk YV. Transfer of the anterior C3 levator scapulae motor nerve branch for spinal accessory nerve injury: illustrative case. J Neurosurg Case Lessons. 2022;3(5):CASE21609."},{"issue":"8","key":"b7","series-title":"Laryngoscope","first-page":"1482","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. 2004;114(8):1482\u20131484."},{"issue":"1","key":"b8","series-title":"J Neurosurg Spine","first-page":"112","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. 2017;26(1):112\u2013115."},{"issue":"5","key":"b9","series-title":"J Neurosurg Spine","first-page":"555","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. 2018;28(5):555\u2013561."},{"issue":"6","key":"b10","series-title":"Otolaryngol Head Neck Surg","first-page":"854","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. 2008;139(6):854\u2013856."},{"issue":"4","key":"b11","series-title":"Acta Orthop Scand","first-page":"383","article-title":"Treatment of paralysis of the trapezius muscle by the Eden-Lange operation","volume":"44","author":"Langenski\u00f6ld A","year":"1973","unstructured":"Langenski\u00f6ld A, Ry\u00f6ppy S. Treatment of paralysis of the trapezius muscle by the Eden-Lange operation. Acta Orthop Scand. 1973;44(4):383\u2013388."},{"issue":"8","key":"b12","series-title":"J Shoulder Elbow Surg","first-page":"1307","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. 2015;24(8):1307\u20131313."},{"key":"b13","series-title":"Hand Surg Rehabil","first-page":"S34","article-title":"Tendon transfer for trapezius palsy","volume":"41S","author":"Werthel JD","year":"2022","unstructured":"Werthel JD, Masmejean E, Elhassan B. Tendon transfer for trapezius palsy. Hand Surg Rehabil. 2022;41S:S34\u2013S38."},{"issue":"4","key":"b1","series-title":"J Back Musculoskeletal Rehabil","first-page":"899","article-title":"Spinal accessory nerve injury: A potentially missed cause of a painful, droopy shoulder","volume":"29","author":"Macaluso S","year":"2016","unstructured":"Macaluso S, Ross DC, Doherty TJ, Doherty CD, Miller TA. Spinal accessory nerve injury: A potentially missed cause of a painful, droopy shoulder. J Back Musculoskeletal Rehabil. 2016;29(4):899\u2013904."},{"issue":"3","key":"b2","series-title":"Can J Neurol Sci","first-page":"337","article-title":"Accessory nerve palsy: a review of 23 cases","volume":"18","author":"Berry H","year":"1991","unstructured":"Berry H, MacDonald EA, Mrazek AC. Accessory nerve palsy: a review of 23 cases. Can J Neurol Sci. 1991;18(3):337\u2013341."},{"issue":"16","key":"b3","series-title":"Dtsch Arztebl Int","first-page":"273","article-title":"Iatrogenic nerve injuries: prevalence, diagnosis and treatment","volume":"111","author":"Antoniadis G","year":"2014","unstructured":"Antoniadis G, Kretschmer T, Pedro MT, K\u00f6nig RW, Heinen CP, Richter HP. Iatrogenic nerve injuries: prevalence, diagnosis and treatment. Dtsch Arztebl Int. 2014;111(16):273\u2013279."},{"issue":"6","key":"b4","series-title":"J Hand Surg Eur Vol","first-page":"589","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. 2018;43(6):589\u2013595."},{"issue":"1","key":"b5","series-title":"J Neurosurg Spine","first-page":"133","article-title":"Reconstruction of the spinal accessory nerve with selective fascicular nerve transfer of the upper trunk","volume":"31","author":"Mayer JA","year":"2019","unstructured":"Mayer JA, Hruby LA, Salminger S, Bodner G, Aszmann OC. Reconstruction of the spinal accessory nerve with selective fascicular nerve transfer of the upper trunk. J Neurosurg Spine. 2019;31(1):133\u2013138."},{"issue":"5","key":"b6","series-title":"J Neurosurg Case Lessons","first-page":"CASE21609","article-title":"Transfer of the anterior C3 levator scapulae motor nerve branch for spinal accessory nerve injury: illustrative case","volume":"3","author":"Gatskiy AA","year":"2022","unstructured":"Gatskiy AA, Tretyak IB, Tsymbaliuk YV. Transfer of the anterior C3 levator scapulae motor nerve branch for spinal accessory nerve injury: illustrative case. J Neurosurg Case Lessons. 2022;3(5):CASE21609."},{"issue":"8","key":"b7","series-title":"Laryngoscope","first-page":"1482","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. 2004;114(8):1482\u20131484."},{"issue":"1","key":"b8","series-title":"J Neurosurg Spine","first-page":"112","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. 2017;26(1):112\u2013115."},{"issue":"5","key":"b9","series-title":"J Neurosurg Spine","first-page":"555","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. 2018;28(5):555\u2013561."},{"issue":"6","key":"b10","series-title":"Otolaryngol Head Neck Surg","first-page":"854","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. 2008;139(6):854\u2013856."},{"issue":"4","key":"b11","series-title":"Acta Orthop Scand","first-page":"383","article-title":"Treatment of paralysis of the trapezius muscle by the Eden-Lange operation","volume":"44","author":"Langenski\u00f6ld A","year":"1973","unstructured":"Langenski\u00f6ld A, Ry\u00f6ppy S. Treatment of paralysis of the trapezius muscle by the Eden-Lange operation. Acta Orthop Scand. 1973;44(4):383\u2013388."},{"issue":"8","key":"b12","series-title":"J Shoulder Elbow Surg","first-page":"1307","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. 2015;24(8):1307\u20131313."},{"key":"b13","series-title":"Hand Surg Rehabil","first-page":"S34","article-title":"Tendon transfer for trapezius palsy","volume":"41S","author":"Werthel JD","year":"2022","unstructured":"Werthel JD, Masmejean E, Elhassan B. Tendon transfer for trapezius palsy. 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