Nerve transfer surgery in cervical spinal cord injury: a qualitative study exploring surgical and caregiver participant experiences

Fox, Ida K.; Hoben, Gwendolyn M.; Komaie, Goldie; Novak, Christine B.; Hamm, R. Douglas; Kahn, Lorna C.; Whitehead, Meredith; Juknis, Neringa; Ruvinskaya, Rimma; Mackinnon, Susan E.; James, Aimee S.

doi:10.1080/09638288.2019.1669225

Cited by 12 publications

(6 citation statements)

References 39 publications

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“…Two studies provided histological estimates of axon number in putative recipients, and Jain linked these to the presence of a CMAP in APB on motor NCS 36,50 . Fox et al wrote a qualitative study about the experience of patients with SCI undergoing assessment, surgery, and rehabilitation of nerve transfers 51 . Pertaining to the clinical electrophysiological evaluation, a patient suggested that the EDX provider should have an appreciation of the patient experience in addition to the purpose of the test, its role in the PNT surgery, and be able to explain this to the patient, taking into account how results may affect surgical decision‐making.…”

Section: Resultsmentioning

confidence: 99%

Preoperative electrodiagnostic planning for upper limb peripheral nerve transfers in cervical spinal cord injury: A narrative review

Silverman

Dengler

Song

et al. 2022

PM&R

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Peripheral nerve transfer (PNT) to improve upper limb function following cervical spinal cord injury (SCI) involves the transfer of supralesional donor nerves under voluntary control to intralesional or sublesional lower motor neurons not under voluntary control. Appropriate selection of donor and recipient nerves and surgical timing affect functional outcomes. Although the gold standard of nerve selection is intraoperative nerve stimulation, preoperative electrodiagnostic (EDX) evaluation may help guide surgical planning. Currently there is no standardized preoperative EDX protocol. This study reviews the EDX workup preceding PNT surgery in cervical SCI and proposes an informed EDX protocol to assist with surgical planning. The PICO (Population, Intervention, Comparison, Outcome) framework was used to formulate relevant Medical Subject Headings (MeSH) terms and identify published cases of PNT in cervical SCI in Medline, Embase, CINAHL, and Emcare databases in the last 10 years. The EDX techniques evaluating putative donor nerves, recipient nerve branches, time sensitivity of nerve transfer and other electrophysiological parameters were summarized to guide creation of a preoperative EDX protocol. Needle electromyography (EMG) was the most commonly used EDX technique to identify healthy donor nerves. Although needle EMG has also been used on recipient nerves, compound muscle action potential amplitudes may provide a more accurate determination of recipient nerve health and time sensitivity for nerve transfer. Although there has been progress in presurgical EDX evaluation, EMG and nerve conduction study approaches are variable, and each has limitations in their utility for preoperative planning. There is need for standardization in the EDX evaluation preceding PNT surgery to assist with donor and recipient nerve selection, surgical timing and to optimize outcomes. Based on results of this review, herein we propose the PreSCIse (PRotocol for Electrodiagnosis in SCI Surgery of the upper Extremity) preoperative EDX panel to achieve said goals through an interdisciplinary and patient‐centered approach.

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Section: Resultsmentioning

confidence: 99%

Preoperative electrodiagnostic planning for upper limb peripheral nerve transfers in cervical spinal cord injury: A narrative review

Silverman

Dengler

Song

et al. 2022

PM&R

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“…The majority of participants weighed these factors against the potential for gaining upper limb function. Fox et al 31 found similar motivating factors and barriers among caregivers and individuals with SCI after they had already received nerve transfer. These included the desire for increased selfsufficiency after surgery and the barriers of understanding complex health information, cost, and travel.…”

Section: Being Open To Nerve Transfer With Some Reservationsmentioning

confidence: 87%

Patient perspectives and self‐rated knowledge of nerve transfer surgery for restoring upper limb function in spinal cord injury

Manna

Kardeh

Douglas

et al. 2022

PM&R

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Background: Nerve transfer surgery has the potential to restore upper limb function in patients with spinal cord injury (SCI); however, there has been limited exploration of patient perception of nerve transfer. Objective: To explore the perspectives of patients with chronic SCI (>2 years from injury) on nerve transfer surgery, and to determine if an educational intervention improved participants' perceived knowledge levels about the procedure. Design: Mixed-methods study including qualitative semi-structured interviews and self-reported rating scales. Pre-and post-interviews were completed following an educational presentation. Setting: Two local SCI clinics. Participants: Ten patients with chronic traumatic SCI and neurological level of injury C3-C7 (motor complete or incomplete), recruited via snowball sampling (six male, four female). Intervention: An educational slide presentation on nerve transfer concepts. Main Outcome Measures: The primary study outcome measure is the participants' responses to interview questions. The secondary study outcome measure is their self-reported knowledge levels of nerve transfer before and after education. Results: Regaining upper limb function was a priority for all participants. Although most participants had heard of nerve transfer, none were offered it at the time of their SCI, and only two stated that they had any peers who had undergone the procedure. The educational module significantly increased selfrated scores on understanding of nerve transfer (p < .05). Although all participants were open to nerve transfer after the educational module, they described weighing different factors, including (1) potential for loss versus gain of function, (2) inadequate knowledge about nerve transfer, (3) recovery time, and (4) determining their eligibility for the surgery. Conclusions: These findings suggest that people with SCI have limited understanding of nerve transfer as a potential option and would benefit from educational opportunities to help them make informed decisions. This study may inform the development of patient resources to improve pre-surgical consultation and informed decision-making.

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“…Given currently dissatis ed outcomes and large HICH populations, we need additional intervention to limb hemiplegia [32][33][34][35].Rationales behind the previous C7-to-C7 transfer for the paretic upper limb are beginning to be accepted and understood as scalability [36][37][38][39][40].Reinnervation of the denervated muscles,γ-circuit interruption,and establishing a new pathway remarkably contributed to a motor recovery post-transfer [41,42]. Contralateral lumbar neurotization engaging the similar mechanisms was considered available for a lower limb paresis after central neurological injury.Thus,in this project,we would rather extend the L4-to-L4 transfer to hindlimb hemiplegia than other transfer modalities in rats.…”

Section: Discussionmentioning

confidence: 99%

Customized Neurotization for Hindlimb Hemiplegia After a Hemorrhagic Stroke

Qian

Zheng

Shi

et al. 2020

Preprint

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Background Hemiplegia after hypertensive intracerebral hemorrhage(HICH) is prevalent,devasta-ting,and currently unable to intervene satisfactorily.Established success in neurotization spurs our interest in restoring skilled lower-limb movement.Here,we explored whether contralesional L4 transfer to ipsilesional L4 root,featuring simultaneous invigoration of flexors and extensors,reanimated dexterous locomotion for the hemiplegic hindlimb after HICH.Methods We manufactured eligible rat models by injecting autologous vein blood into the left posterior limb of internal capsule (PLIC) and randomized thirty rats into three groups. We did not transect but expose bilateral L4 in group A (sham operation) after injection of saline,and infused equal blood followed by bilateral L4 transection and contralateral L4 transfer,in group B and group C,respectively.Behavioral,ultrastru-ctural,immunofluorescent,and electromyographic assessments were applied to efficacy analysis.MRI localized the PLIC impact.Results We could see marked reduction in movements and capture a denervated potential in the right hindlimb of model rats (P༞0.05).In the walking tests,group C exhibited an initially high slip,but,later, a larger increment in accuracy on the paretic side, compared to group B and group A(P༜0.001).Also,at Week 17,rats gained ∼58.2% accuracy and actuated ankle motions in group C(P༞0.05). In the retrograde tracing,at Week 9,fluoro-gold labeled motoneurons had been numerously present in the left anterior horn of the spinal cord from the L4-to-L4 root.Histological and ultra-microstructural assessments certified efficient axons regeneration.Electrom-yography and pawprint analysis implied the denervated muscles were reliably reinnervated,and myodynamia improvement(p>0.05).Conclusions Contralateral L4 transfer could render favorable outcomes for major joints,particularly for the ankle,therefore efficaciously repaired the hemiplegic hindlimb after HICH.

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Nerve transfer surgery in cervical spinal cord injury: a qualitative study exploring surgical and caregiver participant experiences

Cited by 12 publications

References 39 publications

Preoperative electrodiagnostic planning for upper limb peripheral nerve transfers in cervical spinal cord injury: A narrative review

Preoperative electrodiagnostic planning for upper limb peripheral nerve transfers in cervical spinal cord injury: A narrative review

Patient perspectives and self‐rated knowledge of nerve transfer surgery for restoring upper limb function in spinal cord injury

Customized Neurotization for Hindlimb Hemiplegia After a Hemorrhagic Stroke

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