Turkish Neurosurgery 2014 , Vol 24 , Num 4
Neurotization of the Phrenic Nerve with Accessory Nerve for High Cervical Spinal Cord Injury with Respiratory Distress: An Anatomic Study
Ce WANG, Ying ZHANG, Tsai NICHOLAS, Guoxin WU, Sheng SHI, Yin BO, Xinwei WANG, Xuhui ZHOU, Wen YUAN
Second Military Medical University of China, Changzheng Hospital, Department of Orthopedics, Shanghai, China DOI : 10.5137/1019-5149.JTN.8335-13.1 AIM: High cervical spinal cord injury is associated with high morbidity and mortality. Traditional treatments carry various complications such as infection, pacemaker failure and undesirable movement. Thus, a secure surgical strategy with fewer complications analogous to physiological ventilation is still required. We hope to offer one potential method to decrease the complications and improve survival qualities of patients from the aspect of anatomy. The purpose of the study is to provide anatomic details on the accessory nerve and phrenic nerve for neurotization in patients with high spinal cord injuries.

MATERIAL and METHODS: 38 cadavers (76 accessory and 76 phrenic nerves) were dissected in the study. The width, length and thickness of each accessory nerve and phrenic nerve above clavicle were measured. The distances from several landmarks on accessory nerve to the origin and the end of the phrenic nerve above clavicle were measured too. Then, the number of motor nerve fibers on different sections of the nerves was calculated using the technique of immunohistochemistry.

RESULTS: The accessory nerves distal to its sternocleidomastoid muscular branches were 1.52▒0.32mm ~1.54▒0.29mm in width, 0.52▒ 0.18mm ~ 0.56▒0.20mm in thickness and 9.52▒0.98cm in length. And the phrenic nerves above clavicle were 1.44▒0.23mm ~ 1.45▒0.24mm in width, 0.47▒0.15mm ~ 0.56▒0.25mm in thickness and 6.48▒0.78cm in length. The distance between the starting point of accessory nerve and phrenic nerve were 3.24▒1.17cm, and the distance between the starting point of accessory nerve and the end of the phrenic nerve above clavicle were 8.72▒0.84cm. The numbers of motor nerve fibers in accessory nerve were 1038▒320~1102▒216, before giving out the sternocleidomastoid muscular branches. The number of motor nerve fibers in the phrenic nerve was 911▒321~1338▒467.

CONCLUSION: The accessory nerve and the phrenic were similar in width, thickness and the number of motor nerve fibers. And the lengths of accessory nerve were long enough for neuritisation with phrenic nerve. Keywords : Phrenic nerve, Accessory nerve, Anatomy, Spinal cord injury, Reconstruction

Corresponding author : Wen Yuan & Xuhui Zhou, acorepie@126.com, yuanwenspine@163.com, zhouxuhuiczyy@126.com