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  4. Nerve transfers in a patient with asymmetrical neurological deficit following traumatic cervical spinal cord injury: simultaneous bilateral restoration of pinch grip and elbow extension. Illustrative case

Nerve transfers in a patient with asymmetrical neurological deficit following traumatic cervical spinal cord injury: simultaneous bilateral restoration of pinch grip and elbow extension. Illustrative case

J Neurosurg Case Lessons, 2022 · DOI: 10.3171/CASE22301 · Published: October 3, 2022

Spinal Cord InjuryNeurologySurgery

Simple Explanation

Cervical spinal cord injuries can cause significant loss of motor function in the upper extremities. This study explores the use of nerve transfers to restore function in a patient with an asymmetrical injury. The study uses a combination of neurological exams, MRI, and EMG to identify which muscles can be restored with nerve transfers. They then perform nerve transfers to restore elbow extension and pinch grip in both arms simultaneously. The patient showed significant improvement in upper extremity function, especially with bilateral tasks, indicating that simultaneous bilateral nerve transfers can be beneficial in cases of asymmetrical spinal cord injury.

Study Duration
19 Months
Participants
One 16-year-old male
Evidence Level
Case Report

Key Findings

  • 1
    Following nerve transfers, the patient regained M4 strength in the long head of the triceps brachii bilaterally, indicating successful restoration of elbow extension.
  • 2
    The patient's flexor pollicis longus and deep flexor of the index finger recovered to M4 on the right and M3/M2 on the left, respectively, demonstrating improved pinch grip strength.
  • 3
    The Capabilities of Upper Extremity Questionnaire (CUE-Q) scores significantly improved, with a 400% increase in bilateral arm functionality, highlighting the functional benefits of the nerve transfers.

Research Summary

This case report presents a 16-year-old male with asymmetrical neurological deficits following a traumatic cervical spinal cord injury who underwent simultaneous bilateral nerve transfers to restore pinch grip and elbow extension. The surgical procedure involved nerve transfers from the brachialis motor branch to the anterior interosseous nerve for pinch grip restoration and from the spinal accessory nerve to the long head of the triceps brachii muscle for elbow extension. At 19 months post-surgery, the patient showed significant improvements in muscle strength and upper extremity functionality, as measured by the CUE-Q, demonstrating the potential benefits of simultaneous bilateral nerve transfers in patients with asymmetrical cervical spinal cord injuries.

Practical Implications

Surgical Planning

Comprehensive preoperative assessments, including neurological exams, MRI, and EMG, are crucial for identifying suitable donor and target nerves for nerve transfer surgeries in cervical spinal cord injury patients.

Bilateral Approach

Simultaneous bilateral nerve transfers can significantly improve overall upper extremity function and bimanual coordination in patients with asymmetrical cervical spinal cord injuries, enhancing their ability to perform activities of daily living.

Rehabilitation Strategies

Postoperative rehabilitation, including the use of orthotics, is essential for maximizing the benefits of nerve transfer surgeries and improving functional outcomes in patients with cervical spinal cord injuries.

Study Limitations

  • 1
    Single case report limits generalizability
  • 2
    Asymmetrical injury patterns create individual variations in outcomes
  • 3
    Reliance on subjective CUE-Q scores

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