Comparing surgeries to restore upper extremity function in tetraplegia: Impact on function during the perioperative period

The Journal of Spinal Cord Medicine, 2025 · DOI: 10.1080/10790268.2023.2283238 · Published: January 1, 2025

Spinal Cord Injury Orthopedics Rehabilitation

Simple Explanation

This study compares two surgical techniques, nerve transfer (NT) and tendon transfer (TT), used to improve upper extremity function in individuals with cervical spinal cord injury (SCI). The study also includes a group that did not undergo surgery. The researchers assessed the impact of these interventions on patients' independence and health status in the short term, specifically looking at the period immediately following surgery. The findings suggest that patients undergoing TT surgery experience a decline in independence and health status in the immediate perioperative period, whereas those undergoing NT or no surgery do not experience such decline.

Study Duration

One month follow-up

Participants

34 participants with cervical SCI

Evidence Level

Prospective, comparative cohort pilot study

Key Findings

1
The TT group had a decline in SCIM and SF-36 scores whereas the NT and no surgery groups experienced little change in independence or health status in the immediate perioperative period.
2
Individuals undergoing TT were significantly older at the time of SCI compared to those who chose no surgery.
3
Total SCIM scores at baseline were significantly lower in the NT group compared to the TT group.

Research Summary

This study evaluated the short-term impact of nerve transfer (NT) and tendon transfer (TT) surgeries on upper extremity function in individuals with cervical spinal cord injury (SCI), compared to a non-surgical group. The results indicated that individuals undergoing TT surgery experienced a decline in independence and health status in the immediate postoperative period, as measured by SCIM and SF-36 scores. The NT group, despite having lower baseline function, did not experience a significant decline in function or health status postoperatively, suggesting differences in perioperative needs between the two surgical approaches.

Practical Implications

Perioperative Planning

Healthcare providers need to recognize the differences in perioperative needs for patients with cervical SCI undergoing restorative upper extremity surgery, especially those undergoing TT.

Preoperative Counseling

Comprehensive preoperative counseling and cross-disciplinary management are essential to prepare patients for the potential temporary loss of independence after TT surgery.

Rehabilitation Strategies

Patients undergoing TT may benefit from a short inpatient rehabilitation admission immediately post-surgery to address the immobilization and non-weight-bearing requirements.

Study Limitations

1
Direct comparison of outcomes is limited by small sample size, limited outcome measures, and heterogeneity in baseline functioning across the study cohorts.
2
The SCIM and SF-36 questionnaires assess overall function and are not specific to the operative extremity.
3
Future work should collect more specific data including standardized measures of movement such as the International Classification for Surgery of the Hand in Tetraplegia (ICSHT).

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