Nerve Transfers After Cervical Spine Surgery: Multi-Institutional Case Series and Review of the Literature

Background: Up to 10% of cervical spine surgeries are complicated by postoperative weakness. Although many patients recover with nonoperative management, some require surgery for restoration of function. Objective: To present the indications and outcomes of patients undergoing nerve transfers after developing weakness secondary to cervical spine decompression. Methods: A retrospective review of patients from 2 academic medical centers who underwent nerve transfer for C5–6 root injury after cervical spine surgery was performed. Results: Of the 10 treated patients, 9 experienced recovery at last follow-up, demonstrating improvements in strength and motion in the affected muscles. Successful nerve transfers occurred between 3 and 8 months after the index spinal surgery and included spinal accessory nerve to suprascapular nerve, triceps branch to anterior division of the axillary nerve, and/or ulnar or median fascicles to motor branches of the musculocutaneous nerve. The unsuccessful patient underwent nerve transfer surgery approximately 11 months after the index operation and failed to obtain functional recovery. Conclusions: Patients who experience C5–6 weakness after cervical spine surgery should be evaluated and considered for nerve transfer surgery if they have continued severe functional deficits at 6 months postoperatively. Earlier referral for nerve transfer is associated with improved functional outcomes in this cohort.