Use of peripheral nerve transfers in tetraplegia: evaluation of feasibility and morbidity

HAND, 2015 · DOI: 10.1007/s11552-014-9677-z · Published: September 12, 2014

Spinal Cord Injury Neurology Orthopedics

Simple Explanation

Peripheral nerve transfers are being used to improve upper extremity function in patients with cervical spinal cord injury (SCI). An expendable donor nerve, over which the patient has volitional control, is coapted to an intact but nonfunctional recipient nerve below the level of SCI to restore volitional control to these muscles. Nerve transfers have several advantages over traditional tendon transfer surgery including no prolonged postoperative immobilization or weight-bearing limitations and less biomechanical limitations. This surgery does not downgrade existing function, uses expendable donor nerve, and has no postoperative immobilization, which might make it a more viable option than traditional tendon transfer and other procedures.

Study Duration

March 2012 and March 2013

Participants

Seven SCI patients with upper extremity dysfunction

Evidence Level

Not specified

Key Findings

1
Nerve transfers can be used to reestablish volitional control of hand function in SCI when performed by skilled microsurgeons.
2
Sacrifice of the brachialis, which is a redundant elbow flexor, does not significantly downgrade function in this uniquely vulnerable patient population.
3
Histomorphometric analysis of the recipient AIN corroborates feasibility of these transfers even years after initial SCI.

Research Summary

This study evaluated the feasibility and perioperative complications of peripheral nerve transfers to improve upper extremity function in cervical spinal cord injury (SCI) patients. The nerve to the brachialis muscle was used as the expendable donor, and the recipients included the anterior interosseous nerve (AIN), nerve branches to the flexor carpi radialis, and flexor digitorum superficialis. The study found that nerve transfers can be used to reestablish volitional control of hand function in SCI without downgrading existing function, using expendable donor nerves, and with minimal perioperative downtime.

Practical Implications

Improved Hand Function

Nerve transfers offer a promising surgical option to restore hand function in patients with cervical SCI, potentially increasing independence and quality of life.

Reduced Morbidity

Compared to traditional tendon transfers, nerve transfers involve less postoperative immobilization and may be a more viable option for some patients.

Careful Patient Selection

Meticulous preoperative and intraoperative assessments are crucial to ensure appropriate patient selection and avoid downgrading existing function.

Use of peripheral nerve transfers in tetraplegia: evaluation of feasibility and morbidity

Simple Explanation

Key Findings

Research Summary

Practical Implications

Improved Hand Function

Reduced Morbidity

Careful Patient Selection

Study Limitations

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Was this summary helpful?

Use of peripheral nerve transfers in tetraplegia: evaluation of feasibility and morbidity

Simple Explanation

Key Findings

Research Summary

Practical Implications

Improved Hand Function

Reduced Morbidity

Careful Patient Selection

Study Limitations

Your Feedback

Was this summary helpful?