Hand function recovery using nerve segment insert grafting in patients with chronic incomplete lower cervical spinal cord injury: a preliminary clinical report

Abstract

Objective:The objective of this study was to show that hand functions could be recovered using nerve segment insert grafting in quadriplegic patients with chronic incomplete lower cervical spinal cord injury (CSCI) (C5/6/7/8).Methods:A retrospective analysis was performed in 18 quadriplegic patients (12 male and 6 female patients; mean age, 27 years; age range, 17–55 years) with chronic incomplete lower CSCI who had undergone nerve segment insert grafting from January 2001 to June 2015. Among the 18 patients, the right upper limb was involved in 7, left upper limb in 4, and bilateral upper limbs in 7 patients.Results:The mean follow-up period was 16 months (range, 3 months–3 years), and all patients exhibited obvious relief of limb spasm. Among all patients, 15 patients experienced no obvious spasm attacks and exhibited recovery of living abilities, i.e., recovery of the hand functions of grasping, holding, and pinching, and recovery of pain and temperature sensation in the fingers and palms; furthermore, they were able to steer an ordinary wheelchair independently postoperatively. The remaining three patients exhibited a significant and continuous improvement in hand functions over time, without any significant donor nerve dysfunction.Conclusions:Nerve segment insert grafting is an effective method that helps recover hand functions in quadriplegic patients with chronic incomplete lower CSCI. Moreover, spasticity can be relieved and partial normal innervation can be obtained in the spastic muscles postoperatively.

Clinical guidelines for neurorestorative therapies in spinal cord injury (2021 China version)

“…Recent clinical reports have described the role of these methods in neurological function recovery in patients with SCI [139][140][141].…”

The 2019 yearbook of Neurorestoratology

“…Even in late phase (> 4 years) high cervical SCI, patients still achieved beneficial outcomes from nerve transfers for motor and sensory restoration [48]. Ding et al [49] reported that long-term follow-up studies of nerve segment insert grafting showed significant hand function recovery in quadriplegic patients with chronic incomplete lower cervical SCI.…”

Finger Kinematics during Human Hand Grip and Release

“…Hand gripping or grasping is a basic movement that involves flexion and extension of multiple joints. Up to now, the studies on human hand grip mainly focus on the range of motion (ROM), including active, passive and functional ROMs [ 11 , 12 , 13 , 14 , 15 ], which are measured statically. Many robotic hands claimed that their ROMs can reach or be close to that of normal hands [ 16 , 17 ].…”