Current Best Peripheral Nerve Transfers for Spinal Cord Injury

Abstract

Learning Objectives: After reviewing this article, the participant should be able to: 1. Understand the anatomy and pathophysiology of spinal cord injury and the resulting upper and lower motor neuron syndromes. 2. Recognize who may benefit from nerve transfers. 3. Understand the role of history, examination, imaging, and electrodiagnostics in the determination of time-sensitive lower motor neuron injury versus non–time-sensitive upper motor neuron injury. 4. Outline the surgical options and perioperative care for those undergoing nerve transfer and the expected outcomes in restoring shoulder, elbow, wrist, and hand function. Summary: This article outlines how to localize and differentiate upper motor neuron from combined upper and lower motor neuron injury patterns in spinal cord injury by means of detailed history, physical examination, imaging, and electrodiagnostic studies to formulate appropriate surgical plans to restore function in this complex population.

Development of Reaching, Grasping & Manipulation indicators to advance the quality of spinal cord injury rehabilitation: SCI-High Project

“…Interventions with the greatest support for their efficacy 39 include: task-specific training; repetitive practice of isolated and integrated functional movements of the shoulder elbow, wrist and hand with or without the application of technology (including Neuromuscular Electrical Stimulation (NMES), and Functional Electrical Stimulation (FES)) 39 and provision of surgical interventions, including tenodesis or peripheral nerve transplant. 40 , 41 For the purpose of this manuscript, NMES refers to as the application of an electrical current of sufficient intensity to elicit or facilitate muscle contraction (i.e. sensorimotor impairments targeted).…”

Improving hand function after spinal cord injury

“…A biceps to triceps tendon transfer should be avoided if the supinator is used as a nerve donor in the same limb because loss of active supination may be disabling. Table 1 outlines the commonly used forearm/hand reconstructive combinations and complements previously published algorithms (Hill and Fox, 2019;Titolo et al, 2019;Ward and Power, 2019).…”

Review of clinical nerve repair strategies for neurorestoration of central nervous system tumor damage

“…The vascular bundle is extracted by the chemical method to cell allogeneic nerve preservation of the basement membrane tube, which has an instructive effect to promote the regeneration of nerve fibers [28]. More experts started to perform similar surgical procedures and showed partial neurological functional improvements [29][30][31][32].…”