Spinal cord bypass surgery using peripheral nerve transfers: review of translational studies and a case report on its use following complete spinal cord injury in a human

Abstract

<jats:p>Spinal cord injury has been studied in a variety of in vitro and in vivo animal models. One promising therapeutic approach involves the transfer of peripheral nerves originating above the level of injury into the spinal cord below the level of injury. A model of spinal cord injury in rodents has shown the growth of peripheral nerve fibers into the spinal cord, with the subsequent development of functional synaptic connections and limb movement. The authors of this paper are currently developing a similar model in felines to assess the cortical control of these novel repair pathways. In an effort to determine whether these neurotization techniques could translate to spinal cord injury in humans, the authors treated a patient by using intercostal nerve transfer following complete acute spinal cord injury. The case presented details a patient with paraplegia who regained partial motor and sensory activity following the transfer of intercostal nerves, originating above the level of the spinal cord injury, into the spinal canal below the level of injury. The patient recovered some of his motor and sensory function. Notably, his recovered hip flexion showed respiratory variation. This finding raises the possibility that intercostal nerve transfers may augment neurological recovery after complete spinal cord injury.</jats:p>

Use of Peripheral Nerve Transfers in Tetraplegia: Evaluation of Feasibility and Morbidity

“…Nerve transfer surgery improves function in patients with PNI [15]. Extrapolation of this well-established surgical technique for those with cervical SCI is a valid approach to augment upper extremity function [6–8, 16, 23, 28, 36]. These preliminary results suggest that sacrifice of the brachialis, which is a redundant elbow flexor, does not significantly downgrade function in this uniquely vulnerable patient population.…”

The Era of Nerve Transfers in Tetraplegic Patients: Our Multidisciplinary Experience

“…If electrically stimulated, they show contractions. Surgery in this case appears relatively timeindependent: a nerve transfer can switch motor control from a redundant and expendable donor to a muscle group distal to the lesion site bypassing the level of injury [32,33]. In this way, the functional motor units are reconnected to the central nervous system, potentially restoring volitional control.…”

Spinal cord injury regeneration using autologous bone marrow-derived neurocytes and rat embryonic stem cells: A comparative study in rats

“…Spinal cord bypass surgery using peripheral nerves[ 4 ], olfactory ensheathing cells[ 5 , 6 ] Schwann cells for transplantation[ 7 ] and neural stem cells (NSC)[ 8 ] have been performed. Studies in animals have shown improvements in injured spinal cord function when cells derived from the embryonic central nervous system of mice were transplanted[ 9 ].…”