Preliminary results of posterior contralateral cervical 7 nerve transposition in the treatment of upper limb plegia after a stroke

Guan, Jingyu; Lin, Jin; Guan, Xueqing; Jin, Qiang; Chen, Lei; Qiao, Shan; Wu, Jianheng; Cai, Xiaodong; Zhang, Doudou; Tao, Wei; Chen, Fuyong; Chen, Yili; Yang, Shaofeng; Fan, Youwu; Wu, Haiwei; Zhang, Han

doi:10.1002/brb3.1821

Cited by 6 publications

(4 citation statements)

References 16 publications

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“…Surgical advancements in contralateral C7 nerve transfer have progressed through anatomical research, favoring the prespinal route optimized by MRI guidance for its shorter regeneration path and avoidance of nerve grafting 44 , 73 . While a posterior spinal route could potentially reduce regeneration distance, it is less commonly used due to the risk of greater trauma, underscoring the preference for the prespinal approach in clinical practice 47 , 49 , 50 , 74 , 75 . As more patients undergo contralateral C7 nerve transfer, unexpected benefits are observed.…”

Section: Discussionmentioning

confidence: 99%

Peripheral nerve transfers for dysfunctions in central nervous system injuries: a systematic review

Xiang,

Wu,

et al. 2024

International Journal of Surgery

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Background: The review highlights recent advancements and innovative uses of nerve transfer surgery in treating dysfunctions caused by central nervous system (CNS) injuries, with a particular focus on spinal cord injury (SCI), stroke, traumatic brain injury, and cerebral palsy. Methods: A comprehensive literature search was conducted regarding nerve transfer for restoring sensorimotor functions and bladder control following injuries of spinal cord and brain, across PubMed and Web of Science from January 1920 to May 2023. Two independent reviewers undertook article selection, data extraction, and risk of bias assessment with several appraisal tools, including the Cochrane Risk of Bias Tool, the JBI Critical Appraisal Checklist, and SYRCLE’s ROB tool. The study protocol has been registered and reported following PRISMA and AMSTAR guidelines. Results: Nine hundred six articles were retrieved, of which 35 studies were included (20 on SCI and 15 on brain injury), with 371 participants included in the surgery group and 192 in the control group. These articles were mostly low-risk, with methodological concerns in study types, highlighting the complexity and diversity. For SCI, the strength of target muscle increased by 3.13 of Medical Research Council grade, and the residual urine volume reduced by more than 100 ml in 15 of 20 patients. For unilateral brain injury, the Fugl-Myer motor assessment (FMA) improved 15.14–26 score in upper extremity compared to 2.35–26 in the control group. The overall reduction in Modified Ashworth score was 0.76–2 compared to 0–1 in the control group. Range of motion (ROM) increased 18.4–80° in elbow, 20.4–110° in wrist and 18.8–130° in forearm, while ROM changed −4.03°−20° in elbow, −2.08°−10° in wrist, −2.26°−20° in forearm in the control group. The improvement of FMA in lower extremity was 9 score compared to the presurgery. Conclusion: Nerve transfer generally improves sensorimotor functions in paralyzed limbs and bladder control following CNS injury. The technique effectively creates a ‘bypass’ for signals and facilitates functional recovery by leveraging neural plasticity. It suggested a future of surgery, neurorehabilitation and robotic-assistants converge to improve outcomes for CNS.

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Section: Discussionmentioning

confidence: 99%

Peripheral nerve transfers for dysfunctions in central nervous system injuries: a systematic review

Xiang,

Wu,

et al. 2024

International Journal of Surgery

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“…One year after the procedure, the distal end of the upper limb was progressively innervated. Guan et al ( 33 ), observed that the average recovery period for motor function following contralateral C7 nerve anastomosis was more than 1 year. After C7 nerve anastomosis, progressively support the damaged limb’s various segments (e.g., elbow, forearm, wrist, etc.).…”

Section: Discussionmentioning

confidence: 99%

Contralateral seventh cervical nerve transfer for central spastic arm paralysis: a systematic review and meta-analysis

Luo,

Yan,

Guo

et al. 2023

Front. Neurol.

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ObjectivesThe specific benefits of a contralateral cervical 7 nerve transplant in people with spastic paralysis of the upper extremity caused by cerebral nerve injury are unclear. To evaluate the efficacy and safety of contralateral C7 nerve transfer for central spastic paralysis of the upper extremity, we conducted a comprehensive literature search and meta-analysis.Materials and methodsPRISMA guidelines were used to search the databases for papers comparing the efficacy of contralateral cervical 7 nerve transfer vs. rehabilitation treatment from January 2010 to August 2022. The finishing indications were expressed using SMD ± mean. A meta-analysis was used to assess the recovery of motor function in the paralyzed upper extremity.ResultsThe meta-analysis included three publications. One of the publications offers information about RCTs and non-RCTs. A total of 384 paralyzed patients were included, including 192 who underwent CC7 transfer and 192 who received rehabilitation. Results from all patients were combined and revealed that patients who had CC7 transfer may have regained greater motor function in the Fugl-Meyer score (SMD 3.52, 95% CI = 3.19–3.84, p < 0.00001) and had superior improvement in range of motion compared to the rehabilitation group (SMD 2.88, 95% CI = 2.47–3.29, p < 0.00001). In addition, the spasticity in the paralyzed upper extremity significantly improved in patients with CC7 transfer (SMD −1.42, 95% CI = −1.60 to −1.25, p < 0.00001).ConclusionOur findings suggested that a contralateral C7 nerve transfer, which has no additional adverse effects on the healthy upper limb, is a preferable method to restore motor function.

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“…To resolve the above limitations, Guan and colleagues developed a modified postspinal approach, thereby leading to lower spastic and better sensory function by short-term follow-up after operation. 24,25 In 2019, Jiang et al 26 were the first to describe a posterior intradural approach in their cadaver feasibility study.…”

Section: Discussionmentioning

confidence: 99%

“…However, the long distances between the donor and recipient nerves increase the difficulty of surgery, significantly prolongs the operative time, and pose a high operative risk. To resolve the above limitations, Guan and colleagues developed a modified postspinal approach, thereby leading to lower spastic and better sensory function by short-term follow-up after operation 24,25. In 2019, Jiang et al 26 were the first to describe a posterior intradural approach in their cadaver feasibility study.…”

Section: Discussionmentioning

confidence: 99%

A Cadaver Feasibility Study of Extradural Contralateral C7 Ventral Root Transfer Technique for Treating Upper Extremity Paralysis

Chang

Wang

et al. 2022

Spine

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Study Design. A total of 6 formalin-fixed cadavers were included in the cadaver feasibility study.Objective. The aim was to ascertain the anatomical feasibility of extradural contralateral C7 ventral root transfer technique by cervical posterior. Summary of Background Data. Upper limb spastic hemiplegia is a common sequela after stroke. In our previous study, the authors established a method by transferring contralateral C7 dorsal and ventral roots to the corresponding C7 dorsal and ventral roots on the affected side in the cervical posterior. Methods. In the present study, six formalin-fixed cadavers were dissected to confirm the anatomical feasibility. Experimental anastomosis in cadavers was conducted. The pertinent lengths of the extradural nerve roots were measured. The tissue structures surrounding regions between the extradural CC7 nerve roots and the vertebral artery were observed. The cervical magnetic resonance imaging scans of 60 adults were used to measure the distance between the donor and recipient nerves. Results. Experimental anastomosis showed that the distance between the donor and recipient nerves was approximately 1 cm; the short segment of the sural nerve needed bridging. The distance between both exit sites of the exit of the extradural dura mater was 33.57 ± 1.55 mm. The length of the extradural CC7 ventral root was 22.00 ± 0.98 mm. The ventral distance (vd) and the dorsal distance (dd) in males were 23.98 ± 1.72 mm and 30.85 ± 2.22 mm (P < 0.05), while those in females were 23.28 ± 1.51 mm and 30.03 ± 2.16 mm, respectively. C7 vertebral transverse process, ligaments, and other soft tissues were observed between the vertebral artery and the extradural C7 nerve root. Conclusion. Under the premise of less trauma, our study shows that the extradural contralateral C7 ventral root transfer technique, in theory, yields better surgical results, including better recovery of motor function and complete preservation of sensory function.

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Preliminary results of posterior contralateral cervical 7 nerve transposition in the treatment of upper limb plegia after a stroke

Abstract: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 6 publications

References 16 publications

Peripheral nerve transfers for dysfunctions in central nervous system injuries: a systematic review

Peripheral nerve transfers for dysfunctions in central nervous system injuries: a systematic review

Contralateral seventh cervical nerve transfer for central spastic arm paralysis: a systematic review and meta-analysis

A Cadaver Feasibility Study of Extradural Contralateral C7 Ventral Root Transfer Technique for Treating Upper Extremity Paralysis

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