Ultrasound versus surgical anatomical landmarks for localization of the spinal accessory and suprascapular nerves in posterior nerve transfer: A comparative clinical study.

Abstract

Posterior spinal accessory nerve (SAN) to suprascapular nerve (SSN) transfer is a well-established procedure for restoration of shoulder function in upper brachial plexus injuries. Nerve localization traditionally relies on anatomical surface landmarks, which may be influenced by surgeon experience and patient-specific anatomy. Ultrasound provides direct visualization of neural and vascular landmarks before incision. We compared ultrasound-guided preoperative localization with conventional anatomical landmark-based localization during posterior SAN-to-SSN nerve transfer. In this prospective, nonrandomized comparative cohort study, 40 consecutive patients undergoing posterior SAN-to-SSN transfer were allocated in an alternating sequence to ultrasound-guided or landmark-based preoperative skin marking (20 patients per group). Outcomes included time to SAN and SSN identification, total operative time, and requirement for wider exploratory dissection. Baseline demographic and injury characteristics were comparable between the groups. Ultrasound localization was associated with shorter time to SAN identification (12.0 ± 2.1 vs. 20.1 ± 3.0 min), SSN identification (58.2 ± 5.3 vs. 72.4 ± 6.1 min), and total operative time (110.4 ± 9.5 vs. 132.6 ± 11.3 min) (all p < 0.001). Wider exploratory dissection was required less frequently in the ultrasound group (15% vs. 60%; p = 0.004). Ultrasound mapping required a mean of 3.0 ± 0.5 min and did not eliminate the overall procedural time advantage when included in workflow analysis. Preoperative ultrasound-guided skin marking was associated with more directed nerve localization, reduced exploratory dissection, and improved operative efficiency during posterior SAN-to-SSN nerve transfer. Ultrasound appears to be a useful adjunct that provides anatomically informed pre-incision guidance while maintaining an overall procedural time benefit. III, prospective nonrandomized comparative cohort study.