Hyperselective neurectomy of thoracodorsal nerve for treatment of the shoulder spasticity: anatomical study and preliminary clinical results
Background Hyperselective neurectomy is a reliable treatment for spasticity. This research was designed to quantify the surgical parameters of hyperselective neurectomy of thoracodorsal nerve for shoulder spasticity through anatomical studies, as well as to retrospectively assess patients who underw...
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| Veröffentlicht in: | Acta neurochirurgica 2023-05, Vol.165 (5), p.1179-1188 |
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| creator | Lin, Weishan Li, Tie Qi, Wenjun Shen, Yundong Xu, Wendong |
| description | Background
Hyperselective neurectomy is a reliable treatment for spasticity. This research was designed to quantify the surgical parameters of hyperselective neurectomy of thoracodorsal nerve for shoulder spasticity through anatomical studies, as well as to retrospectively assess patients who underwent this procedure to provide an objective basis for clinical practice.
Methods
On nine embalmed adult cadavers (18 shoulders), we dissected and observed the branching patterns of thoracodorsal nerve, counted the number of nerve branches, measured the distribution of branch origin point, and determined the length of the surgical incision. Next, we selected five patients who underwent this procedure for shoulder spasticity and retrospectively evaluated (ethic committee: 2022–37) their shoulder function with active/passive range of motion (AROM/PROM) and modified Ashworth scale (MAS).
Results
The anatomical study revealed that the main trunk of thoracodorsal nerve sends out one to three medial branches, with the pattern of only one medial branch being the most common (61.1%); there were significant variations in the branch numbers and nerve distributions; the location of thoracodorsal nerve branches’ entry points into the muscle varied from 27.2 to 67.8% of the length of the arm. Clinical follow-up data showed significant improvement in shoulder mobility in all patients. AROM of shoulder abduction increased by 39.4° and PROM increased by 64.2° (
P
|
| doi_str_mv | 10.1007/s00701-023-05553-2 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2789236430</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2806675502</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-b4ab66d7d33dde659364343435fb05196cdb3cc04db1c67c6d0ce33792bb80403</originalsourceid><addsrcrecordid>eNp9kU-P1iAQxonRuOurX8CDIfHipTothb71ZjbqmmziRc-EwtRlQ0tlqEm_w35oebfrn3gwJMOE-c0Dw8PY8xpe1wDdGyoB6goaUYGUUlTNA3YOfdtUJcDDv_Iz9oToBqBuulY8ZmdC9a1oj3DObi-3BRNhQJv9D-Qzrqmkcdp4HHm-jsnY6GIiE0otFWKMieeEJk845x1CTtdxDQ4Tp8VQ9tbn7S03sylC3pZWyqvbyoHjS8LgJz-btHEb_HxXTkhryPSUPRpNIHx2vx_Y1w_vv1xcVlefP366eHdVWdHJXA2tGZRynRPCOVSyF6pMU5YcB5B1r6wbhLXQuqG2qrPKgUUhur4ZhiO0IA7s1a67pPh9Rcp68mQxBDNjXEk33bFvTqIn9OU_6E1c01xep5sjKNVJWf7_wJqdsikSJRz1kvxURtQ16JNXevdKF1bfeaVPTS_upddhQve75Zc5BRA7QKU0f8P05-7_yP4EYXeiWQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2806675502</pqid></control><display><type>article</type><title>Hyperselective neurectomy of thoracodorsal nerve for treatment of the shoulder spasticity: anatomical study and preliminary clinical results</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Lin, Weishan ; Li, Tie ; Qi, Wenjun ; Shen, Yundong ; Xu, Wendong</creator><creatorcontrib>Lin, Weishan ; Li, Tie ; Qi, Wenjun ; Shen, Yundong ; Xu, Wendong</creatorcontrib><description>Background
Hyperselective neurectomy is a reliable treatment for spasticity. This research was designed to quantify the surgical parameters of hyperselective neurectomy of thoracodorsal nerve for shoulder spasticity through anatomical studies, as well as to retrospectively assess patients who underwent this procedure to provide an objective basis for clinical practice.
Methods
On nine embalmed adult cadavers (18 shoulders), we dissected and observed the branching patterns of thoracodorsal nerve, counted the number of nerve branches, measured the distribution of branch origin point, and determined the length of the surgical incision. Next, we selected five patients who underwent this procedure for shoulder spasticity and retrospectively evaluated (ethic committee: 2022–37) their shoulder function with active/passive range of motion (AROM/PROM) and modified Ashworth scale (MAS).
Results
The anatomical study revealed that the main trunk of thoracodorsal nerve sends out one to three medial branches, with the pattern of only one medial branch being the most common (61.1%); there were significant variations in the branch numbers and nerve distributions; the location of thoracodorsal nerve branches’ entry points into the muscle varied from 27.2 to 67.8% of the length of the arm. Clinical follow-up data showed significant improvement in shoulder mobility in all patients. AROM of shoulder abduction increased by 39.4° and PROM increased by 64.2° (
P
< 0.05). AROM and PROM of shoulder flexion increased by 36.6° and 54.4°, respectively (
P
< 0.05). In addition, the MAS of shoulder abduction (1.8) and flexion (1.2) was both significantly reduced in all patients (
P
< 0.05).
Conclusion
Hyperselective neurectomy of thoracodorsal nerve is effective and stable in the treatment of shoulder spasticity. Intraoperative attention is required to the numbers of the medial branch of thoracodorsal nerve. We recommend an incision in the mid-axillary line that extends from 25 to 70% of the arm length to fully expose each branch.</description><identifier>ISSN: 0942-0940</identifier><identifier>ISSN: 0001-6268</identifier><identifier>EISSN: 0942-0940</identifier><identifier>DOI: 10.1007/s00701-023-05553-2</identifier><identifier>PMID: 36943480</identifier><language>eng</language><publisher>Vienna: Springer Vienna</publisher><subject>Adult ; Anatomy ; Cadavers ; Denervation - methods ; Humans ; Interventional Radiology ; Medicine ; Medicine & Public Health ; Minimally Invasive Surgery ; Muscle Spasticity - surgery ; Muscle, Skeletal - innervation ; Neurology ; Neuroradiology ; Neurosurgery ; Neurosurgical anatomy ; Original Article ; Patients ; Retrospective Studies ; Shoulder ; Spasticity ; Surgical Orthopedics</subject><ispartof>Acta neurochirurgica, 2023-05, Vol.165 (5), p.1179-1188</ispartof><rights>The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-b4ab66d7d33dde659364343435fb05196cdb3cc04db1c67c6d0ce33792bb80403</citedby><cites>FETCH-LOGICAL-c375t-b4ab66d7d33dde659364343435fb05196cdb3cc04db1c67c6d0ce33792bb80403</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00701-023-05553-2$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00701-023-05553-2$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36943480$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lin, Weishan</creatorcontrib><creatorcontrib>Li, Tie</creatorcontrib><creatorcontrib>Qi, Wenjun</creatorcontrib><creatorcontrib>Shen, Yundong</creatorcontrib><creatorcontrib>Xu, Wendong</creatorcontrib><title>Hyperselective neurectomy of thoracodorsal nerve for treatment of the shoulder spasticity: anatomical study and preliminary clinical results</title><title>Acta neurochirurgica</title><addtitle>Acta Neurochir</addtitle><addtitle>Acta Neurochir (Wien)</addtitle><description>Background
Hyperselective neurectomy is a reliable treatment for spasticity. This research was designed to quantify the surgical parameters of hyperselective neurectomy of thoracodorsal nerve for shoulder spasticity through anatomical studies, as well as to retrospectively assess patients who underwent this procedure to provide an objective basis for clinical practice.
Methods
On nine embalmed adult cadavers (18 shoulders), we dissected and observed the branching patterns of thoracodorsal nerve, counted the number of nerve branches, measured the distribution of branch origin point, and determined the length of the surgical incision. Next, we selected five patients who underwent this procedure for shoulder spasticity and retrospectively evaluated (ethic committee: 2022–37) their shoulder function with active/passive range of motion (AROM/PROM) and modified Ashworth scale (MAS).
Results
The anatomical study revealed that the main trunk of thoracodorsal nerve sends out one to three medial branches, with the pattern of only one medial branch being the most common (61.1%); there were significant variations in the branch numbers and nerve distributions; the location of thoracodorsal nerve branches’ entry points into the muscle varied from 27.2 to 67.8% of the length of the arm. Clinical follow-up data showed significant improvement in shoulder mobility in all patients. AROM of shoulder abduction increased by 39.4° and PROM increased by 64.2° (
P
< 0.05). AROM and PROM of shoulder flexion increased by 36.6° and 54.4°, respectively (
P
< 0.05). In addition, the MAS of shoulder abduction (1.8) and flexion (1.2) was both significantly reduced in all patients (
P
< 0.05).
Conclusion
Hyperselective neurectomy of thoracodorsal nerve is effective and stable in the treatment of shoulder spasticity. Intraoperative attention is required to the numbers of the medial branch of thoracodorsal nerve. We recommend an incision in the mid-axillary line that extends from 25 to 70% of the arm length to fully expose each branch.</description><subject>Adult</subject><subject>Anatomy</subject><subject>Cadavers</subject><subject>Denervation - methods</subject><subject>Humans</subject><subject>Interventional Radiology</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Minimally Invasive Surgery</subject><subject>Muscle Spasticity - surgery</subject><subject>Muscle, Skeletal - innervation</subject><subject>Neurology</subject><subject>Neuroradiology</subject><subject>Neurosurgery</subject><subject>Neurosurgical anatomy</subject><subject>Original Article</subject><subject>Patients</subject><subject>Retrospective Studies</subject><subject>Shoulder</subject><subject>Spasticity</subject><subject>Surgical Orthopedics</subject><issn>0942-0940</issn><issn>0001-6268</issn><issn>0942-0940</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kU-P1iAQxonRuOurX8CDIfHipTothb71ZjbqmmziRc-EwtRlQ0tlqEm_w35oebfrn3gwJMOE-c0Dw8PY8xpe1wDdGyoB6goaUYGUUlTNA3YOfdtUJcDDv_Iz9oToBqBuulY8ZmdC9a1oj3DObi-3BRNhQJv9D-Qzrqmkcdp4HHm-jsnY6GIiE0otFWKMieeEJk845x1CTtdxDQ4Tp8VQ9tbn7S03sylC3pZWyqvbyoHjS8LgJz-btHEb_HxXTkhryPSUPRpNIHx2vx_Y1w_vv1xcVlefP366eHdVWdHJXA2tGZRynRPCOVSyF6pMU5YcB5B1r6wbhLXQuqG2qrPKgUUhur4ZhiO0IA7s1a67pPh9Rcp68mQxBDNjXEk33bFvTqIn9OU_6E1c01xep5sjKNVJWf7_wJqdsikSJRz1kvxURtQ16JNXevdKF1bfeaVPTS_upddhQve75Zc5BRA7QKU0f8P05-7_yP4EYXeiWQ</recordid><startdate>20230501</startdate><enddate>20230501</enddate><creator>Lin, Weishan</creator><creator>Li, Tie</creator><creator>Qi, Wenjun</creator><creator>Shen, Yundong</creator><creator>Xu, Wendong</creator><general>Springer Vienna</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TK</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope></search><sort><creationdate>20230501</creationdate><title>Hyperselective neurectomy of thoracodorsal nerve for treatment of the shoulder spasticity: anatomical study and preliminary clinical results</title><author>Lin, Weishan ; Li, Tie ; Qi, Wenjun ; Shen, Yundong ; Xu, Wendong</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-b4ab66d7d33dde659364343435fb05196cdb3cc04db1c67c6d0ce33792bb80403</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Adult</topic><topic>Anatomy</topic><topic>Cadavers</topic><topic>Denervation - methods</topic><topic>Humans</topic><topic>Interventional Radiology</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Minimally Invasive Surgery</topic><topic>Muscle Spasticity - surgery</topic><topic>Muscle, Skeletal - innervation</topic><topic>Neurology</topic><topic>Neuroradiology</topic><topic>Neurosurgery</topic><topic>Neurosurgical anatomy</topic><topic>Original Article</topic><topic>Patients</topic><topic>Retrospective Studies</topic><topic>Shoulder</topic><topic>Spasticity</topic><topic>Surgical Orthopedics</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lin, Weishan</creatorcontrib><creatorcontrib>Li, Tie</creatorcontrib><creatorcontrib>Qi, Wenjun</creatorcontrib><creatorcontrib>Shen, Yundong</creatorcontrib><creatorcontrib>Xu, Wendong</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Neurosciences Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Acta neurochirurgica</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lin, Weishan</au><au>Li, Tie</au><au>Qi, Wenjun</au><au>Shen, Yundong</au><au>Xu, Wendong</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Hyperselective neurectomy of thoracodorsal nerve for treatment of the shoulder spasticity: anatomical study and preliminary clinical results</atitle><jtitle>Acta neurochirurgica</jtitle><stitle>Acta Neurochir</stitle><addtitle>Acta Neurochir (Wien)</addtitle><date>2023-05-01</date><risdate>2023</risdate><volume>165</volume><issue>5</issue><spage>1179</spage><epage>1188</epage><pages>1179-1188</pages><issn>0942-0940</issn><issn>0001-6268</issn><eissn>0942-0940</eissn><abstract>Background
Hyperselective neurectomy is a reliable treatment for spasticity. This research was designed to quantify the surgical parameters of hyperselective neurectomy of thoracodorsal nerve for shoulder spasticity through anatomical studies, as well as to retrospectively assess patients who underwent this procedure to provide an objective basis for clinical practice.
Methods
On nine embalmed adult cadavers (18 shoulders), we dissected and observed the branching patterns of thoracodorsal nerve, counted the number of nerve branches, measured the distribution of branch origin point, and determined the length of the surgical incision. Next, we selected five patients who underwent this procedure for shoulder spasticity and retrospectively evaluated (ethic committee: 2022–37) their shoulder function with active/passive range of motion (AROM/PROM) and modified Ashworth scale (MAS).
Results
The anatomical study revealed that the main trunk of thoracodorsal nerve sends out one to three medial branches, with the pattern of only one medial branch being the most common (61.1%); there were significant variations in the branch numbers and nerve distributions; the location of thoracodorsal nerve branches’ entry points into the muscle varied from 27.2 to 67.8% of the length of the arm. Clinical follow-up data showed significant improvement in shoulder mobility in all patients. AROM of shoulder abduction increased by 39.4° and PROM increased by 64.2° (
P
< 0.05). AROM and PROM of shoulder flexion increased by 36.6° and 54.4°, respectively (
P
< 0.05). In addition, the MAS of shoulder abduction (1.8) and flexion (1.2) was both significantly reduced in all patients (
P
< 0.05).
Conclusion
Hyperselective neurectomy of thoracodorsal nerve is effective and stable in the treatment of shoulder spasticity. Intraoperative attention is required to the numbers of the medial branch of thoracodorsal nerve. We recommend an incision in the mid-axillary line that extends from 25 to 70% of the arm length to fully expose each branch.</abstract><cop>Vienna</cop><pub>Springer Vienna</pub><pmid>36943480</pmid><doi>10.1007/s00701-023-05553-2</doi><tpages>10</tpages></addata></record> |
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| subjects | Adult Anatomy Cadavers Denervation - methods Humans Interventional Radiology Medicine Medicine & Public Health Minimally Invasive Surgery Muscle Spasticity - surgery Muscle, Skeletal - innervation Neurology Neuroradiology Neurosurgery Neurosurgical anatomy Original Article Patients Retrospective Studies Shoulder Spasticity Surgical Orthopedics |
| title | Hyperselective neurectomy of thoracodorsal nerve for treatment of the shoulder spasticity: anatomical study and preliminary clinical results |
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