Restoration of function in complete spinal cord injury using peripheral nerve rerouting: a summary of procedures

Until relatively recently, few procedures have been developed that restore significant motor and sensory function in individuals with obsolete (ie, chronic), complete spinal cord injury (SCI). Building upon the methodology used to treat brachial root avulsion, the authors have developed peripheral nerve-rerouting procedures that have restored some function in hundreds of patients with such SCI. Many of the treated patients have regained life-enhancing function depending upon their injury level, such as walking with assistive devices, partial hand function, urination, sexual sensation, etc. Although sophisticated surgeries, the basic concept is theoretically simple: a functional nerve from above the injury site is rerouted and connected to a paralysis-affected peripheral nerve below the injury site. This Chapter summarizes more than a dozen rerouting procedures, which restore function that range from breathing to toe sensation. This summary discusses the indications and criteria for choosing the best donor nerve based on the specific injury level, and emphasizes major procedural features such as the use of selected interfascicular anastomosis, modified end-to-side suture techniques, vascularized donor nerves, a muscle trigger for the synchronized contraction of congenerous muscles, and reconstruction procedures to restore donor-nerve function.