Unaffected contralateral S1 transfer for the treatment of lumbosacral plexus avulsion

IntroductionThis study describes a new surgical strategy for lumbosacral plexus avulsion by transfer of the unaffected contralateral S1 nerve root.MethodsA surgical reconstruction of the sacral nerve was performed on a 10-year-old boy with left lumbosacral plexus avulsion. The unaffected S1 nerve root (right side) is severed extradurally for transfer. A 25-cm long nerve graft from the common peroneal nerve of the affected side was used as donor nerve. One end of the nerve graft was anastomosed to the proximal stump of the right-sided extradural S1 nerve. The distal end of the nerve graft was divided into two fascicles and anastomosed to the left-sided inferior gluteal nerve and the branch of the sciatic nerve innervating the left-sided hamstrings.ResultsAccording to motor score of the British Medical Research Council (MRC) system, the strength of glutei and hamstrings improved to the level of M3 1.5 years after surgery.ConclusionsThe extradural S1 nerve root in the unaffected side can be considered as a suitable donor nerve for transfer in patients with root avulsion of the lumbar or sacral nerve plexus.