LEVATOR SCAPULAE TRANSFER AND FASCIA LATA FASCIODESIS FOR CHRONIC SPINAL ACCESSORY NERVE PALSY

A retrospective evaluation of the functional results after reconstruct ive treatment with levator scapulae transfer and scapulo-spinal fascio desis by fascia lata slings for complete chronic trapezius palsy is pr esented. Five patients (ages 6 to 40 years) were operated on between 1 988 and 1991 because of incapacitating pain and/or functional limitati ons. Treatment was recommended after failure to alleviate symptoms by a shoulder-girdle muscle-strengthening program or after unsuccessful n erve graft. The descriptions of the results are drawn from the last fo llow-up evaluation available for each patient (minimum: 14 months post -operative). They are expressed in terms of functional recovery, resid ual pain, and patient satisfaction, Three patients had an excellent re sult, with at least 80 percent of normal abduction and forward elevati on of the arm, no residual pain, and a high satisfaction rate. One pat ient showed good improvement in function, with 90 percent of normal sh oulder function, but complained of some residual pain. The last patien t was not improved by the surgery Levator scapulae transfer and scapui o-spinal fasciodesis by fascia lata slings, substitute for the functio n of the upper trapezius and enhance the function of the serratus ante rior, thus helping to relieve pain and to improve shoulder function af ter chronic trapezius palsy. The procedure warrants consideration in p atients who are not candidates for nerve repair and reconstruction.