Contralateral seventh cervical nerve transfer for central spastic arm paralysis: a systematic review and meta-analysis

Luo, WenMiao; Yan, ZhengCun; Guo, Yu; Xu, Ji; Zhang, Heng-Zhu

doi:10.3389/fneur.2023.1113254

Cited by 3 publications

(1 citation statement)

References 30 publications

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“…The anastomosis of the healthy and diseased C7 nerves facilitates the release of spasms and the restoration of motor control in the limbs. Ultimately, a healthy hemisphere assumes control over both upper limbs, enhancing the stiffness and motor function of paralyzed limbs [7].…”

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confidence: 99%

Clinical efficacy analysis of the treatment of central hemiplegia with cervical nerve 7 displacement via anterior cervical approach under microscope

Xiang,

Shi,

et al. 2024

Preprint

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Objective: To investigate the clinical effectiveness and prognosis of contralateral C7 nerve transfer via the anterior cervical approach in the treatment of central hemiplegia. Method: The clinical data of patients with central hemiplegia admitted to the Neurosurgery Department of Suining Central Hospital between 2022 and 2023 were retrospectively analyzed. All cases were categorized into an experimental group and a control group. The experimental group comprised patients who underwent cervical 7 nerve transfer surgery; The control group included patients who received physical rehabilitation therapy during the same period and matched the age and general conditions of the surgical patients. The rehabilitation progress of the surgical and physical rehabilitation groups was compared at three time points: before treatment, six months post-treatment, and twelve months post-treatment. Indicators collected included: Modified Ashworth Scale (MAS) grades to assess muscle tone in the affected limbs; Fugl-Meyer Motor Function Assessment (FMA) scores to evaluate upper limb motor function; Berg Balance Scale (BBS) scores to assess balance function; and Boston Diagnostic Aphasia Examination (BDAE) grades to evaluate language function. Statistical Analysis: Data were analyzed using SPSS 25.0 statistical software. Repeated measures analysis of variance was applied for the Fugl–Meyer, BDAE, and BBS scores, while independent sample t-tests were used for comparing the two groups at the same time point. Bonferroni tests were applied for pair-wise comparisons between the same group at different time points. Mann-Whitney tests were used for the MAS scores. Differences were considered statistically significant with P<0.05. All methods were in accordance with the relevant guidelines and regulations of Suining Central Hospital Result:All surgical patients successfully completed their procedures, with an average duration of approximately 6 hours. Postoperatively, the unaffected limbs exhibited varying degrees of pain, yet their movement remained within normal limits. There were no complications including wound infections or bleeding in the surgical areas. The Fugl-Meyer assessment scale revealed significant improvements in motor function for both the surgical and physical rehabilitation groups, with the surgical group outperforming the physical rehabilitation group, especially in terms of upper limb stiffness and movement (p＞0.05); Conclusion: This study demonstrates that CC7 nerve cross transfer surgery effectively, safely, and sustainably improves spasticity, balance, and upper limb motor function in patients with unilateral spastic arm paralysis, without significant contralateral limb dysfunction or serious complications. The high clinical efficacy and safety of the procedure provide a basis for expanding its indications to a broader population of hemiplegic patients. The primary limitation of this study is its retrospective design, with selection biases and potential confounding factors persisting even after closely matching key characteristics. Consequently, the findings should be interpreted with caution. Additional multicenter studies are warranted to further assess its effectiveness and safety.

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confidence: 99%

Clinical efficacy analysis of the treatment of central hemiplegia with cervical nerve 7 displacement via anterior cervical approach under microscope

Xiang,

Shi,

et al. 2024

Preprint

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Nerve-Targeted Surgical Treatments for Spasticity: A Narrative Review

Ran,

Das,

Johnston

et al. 2024

World Neurosurgery

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Resting-state brain network remodeling after different nerve reconstruction surgeries: a functional magnetic resonance imaging study in brachial plexus injury rats

Xiang,

Xing,

Hua

et al. 2024

Neural Regeneration Research

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JOURNAL/nrgr/04.03/01300535-202505000-00031/figure1/v/2024-07-28T173839Z/r/image-tiff Distinct brain remodeling has been found after different nerve reconstruction strategies, including motor representation of the affected limb. However, differences among reconstruction strategies at the brain network level have not been elucidated. This study aimed to explore intra-network changes related to altered peripheral neural pathways after different nerve reconstruction surgeries, including nerve repair, end-to-end nerve transfer, and end-to-side nerve transfer. Sprague–Dawley rats underwent complete left brachial plexus transection and were divided into four equal groups of eight: no nerve repair, grafted nerve repair, phrenic nerve end-to-end transfer, and end-to-side transfer with a graft sutured to the anterior upper trunk. Resting-state brain functional magnetic resonance imaging was obtained 7 months after surgery. The independent component analysis algorithm was utilized to identify group-level network components of interest and extract resting-state functional connectivity values of each voxel within the component. Alterations in intra-network resting-state functional connectivity were compared among the groups. Target muscle reinnervation was assessed by behavioral observation (elbow flexion) and electromyography. The results showed that alterations in the sensorimotor and interoception networks were mostly related to changes in the peripheral neural pathway. Nerve repair was related to enhanced connectivity within the sensorimotor network, while end-to-side nerve transfer might be more beneficial for restoring control over the affected limb by the original motor representation. The thalamic-cortical pathway was enhanced within the interoception network after nerve repair and end-to-end nerve transfer. Brain areas related to cognition and emotion were enhanced after end-to-side nerve transfer. Our study revealed important brain networks related to different nerve reconstructions. These networks may be potential targets for enhancing motor recovery.

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Contralateral seventh cervical nerve transfer for central spastic arm paralysis: a systematic review and meta-analysis

Cited by 3 publications

References 30 publications

Clinical efficacy analysis of the treatment of central hemiplegia with cervical nerve 7 displacement via anterior cervical approach under microscope

Clinical efficacy analysis of the treatment of central hemiplegia with cervical nerve 7 displacement via anterior cervical approach under microscope

Nerve-Targeted Surgical Treatments for Spasticity: A Narrative Review

Resting-state brain network remodeling after different nerve reconstruction surgeries: a functional magnetic resonance imaging study in brachial plexus injury rats

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