# Woodward procedure with intraoperative neuromonitoring for Sprengel deformity: a retrospective study with a mean 5-year follow-up

## TL;DR

This study shows that the Woodward procedure with clavicle osteotomy and nerve monitoring improves function and appearance in Sprengel deformity patients with few complications.

## Contribution

Combining clavicle osteotomy and intraoperative neuromonitoring with the Woodward procedure for Sprengel deformity is shown to reduce nerve injury risks and improve outcomes.

## Key findings

- Shoulder abduction improved by an average of 74° post-surgery.
- Cavendish and Rigault grades improved significantly, indicating better function and appearance.
- No brachial plexus injuries occurred, with only minor complications reported.

## Abstract

The Woodward procedure was designed to correct Sprengel deformity (SD) while brachial plexus injury remains a critical complication. This study aimed to assess the effectiveness of the Woodward procedure with clavicle osteotomy and intraoperative neuromonitoring (IONM) in enhancing postoperative functional outcomes, cosmetic appearance, and nerve injury prevention.

We retrospectively reviewed the records of patients who underwent the Woodward procedure with clavicle osteotomy and IONM for Sprengel deformity at our institution between January 2013 and May 2023. Patient demographics, clinical and cosmetic outcomes before and after surgery, and complications were analyzed.

A total of 36 patients (female: male = 16:20) with a mean age of 4.1 ± 1.5 years were included, with a mean follow-up of 5.6 years. Intraoperatively, no IONM alerts occurred. At the latest follow-up, shoulder abduction improved by an average of 74°, and Cavendish grade improved from grade 3 or 4 preoperatively to grade 1 or 2. Radiographic analysis showed Rigault grade improvement from grade 3 to grade 1 or 2. Aside from a single instance of delayed wound healing and one case of hypertrophic scarring, no brachial plexus injuries or long-term complications were observed.

Woodward procedure combined with clavicle osteotomy and IONM for SD patients is associated with significant improvement in postoperative functional outcome, cosmetic appearance, low risk of complications and high levels of satisfaction.