Nerve Transfers to Restore Upper Extremity Function in Cervical Spinal Cord Injury

Fox, Ida K.; Davidge, Kristen M.; Novak, Christine B.; Hoben, Gwendolyn M.; Kahn, Lorna C.; Juknis, Neringa; Ruvinskaya, Rimma; Mackinnon, Susan E.

doi:10.1097/prs.0000000000001641

Cited by 65 publications

(64 citation statements)

References 50 publications

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“…Some surgeons have suggested that motor axons preferentially reinnervate sensory pathways. 4,21 Fox et al 12 have also observed the absence of M4 finger flexion strength recovery following transfer of the nerve to the brachialis to median nerve motor fascicles in the arm. In contrast, Krasuski and Kiwerski 19 observed M4 finger flexion strength recovery in 16 of 42 tetraplegic patients in whom the branch to the brachialis and the lateral antebrachial cutaneous nerve were transferred to the median nerve.…”

Section: Discussion Restoration Of Finger Flexionmentioning

confidence: 96%

“…More recently the use of distal nerve transfers has emerged as an adjunct therapy to improve upper limb function in patients with tetraplegia. 6,12 In this strategy, by crossing peripheral nerves, axons from motoneurons that originate above the lesion level and have functional cortical drive are rerouted to reinnervate target muscles that are normally innervated by motoneurons located below the spinal cord lesion. In patients with midcervical spinal cord injuries, distal nerve transfer resulted in predictable restoration of elbow and finger extension with a single surgery, no postoperative casting, and only 1 day of hospitalization.…”

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confidence: 99%

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Nerve transfers for restoration of finger flexion in patients with tetraplegia

Bertelli

Ghizoni

2017

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OBJECTIVE The purpose of this paper was to report the authors' results with finger flexion restoration by nerve transfer in patients with tetraplegia. METHODS Surgery was performed for restoration of finger flexion in 17 upper limbs of 9 patients (8 male and 1 female) at a mean of 7.6 months (SD 4 months) after cervical spinal cord injury. The patients' mean age at the time of surgery was 28 years (SD 15 years). The motor level according to the ASIA (American Spinal Injury Association) classification was C-5 in 4 upper limbs, C-6 in 10, and C-7 in 3. In 3 upper limbs, the nerve to the brachialis was transferred to the anterior interosseous nerve (AIN), which was separated from the median nerve from the antecubital fossa to the midarm. In 5 upper limbs, the nerve to the brachialis was transferred to median nerve motor fascicles innervating finger flexion muscles in the midarm. In 4 upper limbs, the nerve to the brachioradialis was transferred to the AIN. In the remaining 5 upper limbs, the nerve to the extensor carpi radialis brevis (ECRB) was transferred to the AIN. Patients were followed for an average of 16 months (SD 6 months). At the final evaluation the range of finger flexion and strength were estimated by manual muscle testing according to the British Medical Research Council scale. RESULTS Restoration of finger flexion was observed in 4 of 8 upper limbs in which the nerve to the brachialis was used as a donor. The range of motion was incomplete in all 5 of these limbs, and the strength was M3 in 3 limbs and M4 in 1 limb. Proximal retrograde dissection of the AIN was associated with better outcomes than transfer of the nerve to the brachialis to median nerve motor fascicles in the arm. After the nerve to the brachioradialis was transferred to the AIN, incomplete finger flexion with M4 strength was restored in 1 limb; the remaining 3 limbs did not show any recovery. Full finger flexion with M4 strength was demonstrated in all 5 upper limbs in which the nerve to the ECRB was transferred to the AIN. No functional downgrading of elbow flexion or wrist extension strength was observed. CONCLUSIONS In patients with tetraplegia, finger flexion can be restored by nerve transfer. Nerve transfer using the nerve to the ECRB as the donor nerve produced better recovery of finger flexion in comparison with nerve transfer using the nerve to the brachialis or brachioradialis.

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Section: Discussion Restoration Of Finger Flexionmentioning

confidence: 96%

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confidence: 99%

Nerve transfers for restoration of finger flexion in patients with tetraplegia

Bertelli

Ghizoni

2017

SPI

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“…Candidacy for nerve transfer surgery has yet to be definitively outlined. Our previous work [9,10,24], as well as contributions from others [6][7][8][11][12][13]25,26], suggest that results after nerve transfer surgery are promising, although studies [27,28] show variable outcomes. This emphasizes the need for careful and comprehensive preoperative patient evaluation using standardized functional assessments to better define surgical candidacy and outcomes of nerve transfer surgery in patients with SCI.…”

Section: Discussionmentioning

confidence: 97%

“…The limitations of tendon transfers include limited tendon/muscle donors and a long duration of postoperative immobilization. Newer treatment options such as nerve transfer surgery [1][2][3][5][6][7][8][9][10][11][12][13] could improve eligibility or desirability for reconstructive surgery.…”

Section: Introductionmentioning

confidence: 99%

The Use of Nerve Transfers to Restore Upper Extremity Function in Cervical Spinal Cord Injury

Fox

Novak

Krauss

et al. 2018

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“… 32) There are a few significant nerve transfer procedures that showed predictable results. 6 7 11 17 18 20 21) …”

Section: What Kind Of Nerve Transfer Surgery Can Be Done?mentioning

confidence: 99%

Upper Limb Reconstruction in Tetraplegic Patients: A Primer for Spinal Cord Injury Specialists

Liew

Shim

Gong

2020

Korean J Neurotrauma

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Cervical spinal cord injury (SCI) often causes debilitating loss of function of the upper limb. Upper extremity reconstruction surgery can restore some of the upper limb function in tetraplegic patients with SCI. The procedures are typically muscle-tendon unit transfer surgeries, which redistribute the remaining functional muscles to restore active elbow extension, key grip, and finger grasping. In addition to the tendon transfer surgeries, nerve transfers have emerged recently and are showing promising results. However, despite more than half of the tetraplegic patients can benefit from upper limb surgery, only a few of them receive the procedures. This missed opportunity may be due to the lack of communication between SCI specialists and hand surgeons, or the lack of awareness of such options among the specialists and patients. In this review, we provide a basic overview of upper limb reconstruction in tetraplegic patients with target audience of SCI specialists for their better understanding of the basic concept of surgery and information for patient consultation before referring to hand surgeons.

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Nerve Transfers to Restore Upper Extremity Function in Cervical Spinal Cord Injury

Abstract: Therapeutic, IV.

Cited by 65 publications

References 50 publications

Nerve transfers for restoration of finger flexion in patients with tetraplegia

Nerve transfers for restoration of finger flexion in patients with tetraplegia

The Use of Nerve Transfers to Restore Upper Extremity Function in Cervical Spinal Cord Injury

Upper Limb Reconstruction in Tetraplegic Patients: A Primer for Spinal Cord Injury Specialists

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