Single Versus Double Fascicular "Oberlin" Nerve Transfer to Restore Elbow Flexion in Brachial Plexus Injury

Abdel-Hameed Al-Mistarehi, Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Jawad M. Khalifeh, Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Chase H. Foster, Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Abdul Karim Ghaith, Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Taha Khalilullah, Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Xinlan Yang, Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Yuanxuan Xia, Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Mohammad Faizan Khan, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Avi N. Albert, Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Joseph Rajasekaran, Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Bhavya Pahwa, University College of Medical Sciences, Delhi, India.
Sami Tuffaha, Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Allan J. Belzberg, Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Daniel Lubelski, Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

Document Type

Journal Article

Publication Date

7-28-2025

Journal

Operative neurosurgery (Hagerstown, Md.)

DOI

10.1227/ons.0000000000001722

Keywords

Brachial plexus; Double; Elbow flexion; Nerve transfer; Oberlin; Single

Abstract

BACKGROUND AND OBJECTIVES: Brachial plexus injury (BPI) is a disabling condition, with elbow flexion restoration as a key surgical goal. The Oberlin procedure involves either single fascicular transfer (SFT) using an ulnar nerve fascicle or double fascicular transfer (DFT), which adds a median nerve fascicle. This study compares SFT and DFT for improving elbow flexion strength at short-term and long-term time postoperative dates. METHODS: This retrospective single-center cohort study included patients with BPI who underwent elbow flexion neurotization using SFT or DFT between February 2017 and March 2022. Clinical and perioperative data were collected, including injury type and severity, root involvement, electrodiagnostic findings, and timing. Elbow flexion strength was evaluated using the Medical Research Council (MRC) scale preoperatively and at follow-up visits (6 months, ≤1 year, ≤2 years, and >2 years). RESULTS: Of 39 patients, 22 (56.4%) underwent SFT and 17 (43.6%) underwent DFT. SFT patients were significantly younger (P = .029). DFT was more common in isolated upper trunk injuries (82.4%), whereas SFT was preferred in cases with multiple cervical root involvement (P = .068). Overall, 82% achieved MRC ≥3 (P = .037), including 91% in SFT and 71% in DFT groups (P = .231). SFT patients showed earlier improvement by 6 months, whereas DFT patients showed significant gains from ≤1 year onward. On multivariate analysis, better outcomes were associated with higher preoperative MRC (M1: odds ratio [OR] = 5.91, P = .162; M2: OR = 174.10, P = .031) and younger age (OR = 0.91, P = .018). Procedure type was not significantly associated with final MRC (OR = 4.28, P = .318). CONCLUSION: Nerve transfer effectively restores elbow flexion after upper BPI. SFT and DFT both offer comparable MRC improvement to enhance patient outcomes after BPI.

Department

School of Medicine and Health Sciences Resident Works

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