Nerve Transfers in Patients with Brown-Séquard Pattern of Spinal Cord Injury: Report of 2 Cases

Loch-Wilkinson, Thorbjorn; McNeil, Stephen; White, C Michael; Schrag, Christiaan; Midha, Rajiv

doi:10.1016/j.wneu.2017.10.169

Cited by 3 publications

(4 citation statements)

References 8 publications

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“…Finally, Loch‐Wilkinson et al and Friden et al each described use of EMG of donors in the less typical transfers. In a 38‐year‐old man with C5 Brown‐Sequard (hemicord) syndrome with good distal hand recovery, needle EMG was used to determine that proximal weakness was due to an upper trunk (brachial plexus) injury, and EMG of triceps and flexor carpi ulnaris were used to plan transfers to deltoid and brachialis, respectively (opposite the typical SCI peripheral nerve transfer techniques) 42 . In a second case report of brachialis‐to‐extensor carpi radialis longus transfer, preoperative EMG showed that donor innervation was intact and under voluntary control 43 …”

Section: Resultsmentioning

confidence: 99%

“…Eighteen articles discussed evaluation of putative recipients. Considering the time of publication, the earlier studies focused on utility of EMG to differentiate LMN injuries in potential recipients from paralyzed muscles with reduced activation (no motor units) below the level of injury 10,35,40,42–45 . A few more recent studies discovered better accuracy with NCS in predicting recipient nerve quality 36 …”

Section: Resultsmentioning

confidence: 99%

“…Considering the time of publication, the earlier studies focused on utility of EMG to differentiate LMN injuries in potential recipients from paralyzed muscles with reduced activation (no motor units) below the level of injury. 10,35,40,[42][43][44][45] A few more recent studies discovered better accuracy with NCS in predicting recipient nerve quality. 36 EMG: Studies listed needling of potential recipient muscles including medial, lateral, and long heads of triceps (for axillary-to-triceps transfer), FPL and FDP2,3 (for the brachialis-to-AIN transfer), and various PINinnervated muscles: EI, extensor digitorum (ED), extensor carpi ulnaris, extensor pollicis longus, and extensor digiti minimi (for the supinator-to-PIN transfer).…”

Section: Evaluation Of Recipient Nerve Qualitymentioning

confidence: 99%

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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%

Section: Resultsmentioning

confidence: 99%

Section: Evaluation Of Recipient Nerve Qualitymentioning

confidence: 99%

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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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“…7,8,30 Clinically, contusive STT-sparing hemicord lesions are rare but can result in contralateral pruritus 27 and neuropathic pain. 16 For these reasons, we suggest that progressive deterioration of contralateral reaching relies on residual but abnormal STT function, an idea that could be tested in the future using complete (STT-severing) spinal hemisection. The absence of any ipsilateral influence of PGB also argues against a direct effect on motor circuitry.…”

Section: Discussionmentioning

confidence: 99%

Skilled reaching deterioration contralateral to cervical hemicontusion in rats is reversed by pregabalin treatment conditional upon its early administration

Erskine¹,

Smaila²,

Plunet³

et al. 2019

PR9

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Introduction:Gabapentinoids are first-line treatments for painful traumatic and nontraumatic central nervous system disorders. Evidence from a large human study suggests that early use of gabapentinoids after spinal cord injury improves motor scores. The underlying mechanism is unknown.Objectives:We sought to examine the effects of early pregabalin (PGB, a gabapentinoid) treatment on performance in a fine motor task (skilled reaching) after cervical hemicontusion. We also asked whether early PGB administration affected PGB responsiveness later on.Methods:Rats received C4/5 cervical hemicontusions. Injury severities ranged from 80 to 150 kdyn. We monitored evidence of skin irritation (peri-incisional and elsewhere) and quantified food pellet retrieval using the Montoya staircase test. Behaviours were assessed in rats receiving early (for 3 weeks from injury induction) and/or late (resuming or beginning at week 8) PGB treatment in animals with 150-kdyn injuries.Results:Contralateral skilled reaching waned in control animals with 150-kdyn injuries. This was prevented in animals, which received early PGB as long as treatment continued. Deterioration of skilled reaching was reversed by later (week 8) PGB only in animals that had received early treatment. Ipsilateral reaching impairment was not improved by PGB. Relief of skin irritation verified early PGB efficacy.Conclusion:Hemicontusive spinal cord injury produces a contralateral motor phenotype evocative of on-going neuropathic pain. Early PGB preserves sensitivity to subsequent PGB treatment, indicating that motor function is impaired by neuropathic pain and can be improved indirectly by early PGB administration. Direct effects of PGB on motor circuitry cannot be excluded but are not supported by our data.

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Nerve transfers in the upper extremity following cervical spinal cord injury. Part 1: Systematic review of the literature

Khalifeh

Dibble

Voorhis³

et al. 2019

Journal of Neurosurgery: Spine

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OBJECTIVEPatients with cervical spinal cord injury (SCI)/tetraplegia consistently rank restoring arm and hand function as their top functional priority to improve quality of life. Motor nerve transfers traditionally used to treat peripheral nerve injuries are increasingly being used to treat patients with cervical SCIs. In this study, the authors performed a systematic review summarizing the published literature on nerve transfers to restore upper-extremity function in tetraplegia.METHODSA systematic literature search was conducted using Ovid MEDLINE 1946–, Embase 1947–, Scopus 1960–, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and clinicaltrials.gov to identify relevant literature published through January 2019. The authors included studies that provided original patient-level data and extracted information on clinical characteristics, operative details, and strength outcomes after nerve transfer procedures. Critical review and synthesis of the articles were performed.RESULTSTwenty-two unique studies, reporting on 158 nerve transfers in 118 upper limbs of 92 patients (87 males, 94.6%) were included in the systematic review. The mean duration from SCI to nerve transfer surgery was 18.7 months (range 4 months–13 years) and mean postoperative follow-up duration was 19.5 months (range 1 month–4 years). The main goals of reinnervation were the restoration of thumb and finger flexion, elbow extension, and wrist and finger extension. Significant heterogeneity in transfer strategy and postoperative outcomes were noted among the reports. All but one case report demonstrated recovery of at least Medical Research Council grade 3/5 strength in recipient muscle groups; however, there was greater variation in the results of larger case series. The best, most consistent outcomes were demonstrated for restoration of wrist/finger extension and elbow extension.CONCLUSIONSMotor nerve transfers are a promising treatment option to restore upper-extremity function after SCI. Flexor reinnervation strategies show variable treatment effect sizes; however, extensor reinnervation may provide more consistent, meaningful recovery. Despite numerous published case reports describing good patient outcomes with nerve transfers, there remains a paucity in the literature regarding optimal timing and long-term clinical outcomes with these procedures.

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Nerve Transfers in Patients with Brown-Séquard Pattern of Spinal Cord Injury: Report of 2 Cases

Cited by 3 publications

References 8 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

Skilled reaching deterioration contralateral to cervical hemicontusion in rats is reversed by pregabalin treatment conditional upon its early administration

Nerve transfers in the upper extremity following cervical spinal cord injury. Part 1: Systematic review of the literature

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