The Use of Nerve Transfers to Restore Upper Extremity Function in Cervical Spinal Cord Injury

Area of Science:

• Neurosurgery
• Reconstructive Surgery
• Spinal Cord Injury Research

Background:

• Nerve transfer surgery offers a novel approach to restoring upper extremity function in individuals with cervical spinal cord injury (SCI).
• Identifying suitable candidates for nerve transfer, particularly years after SCI, remains a challenge due to undefined eligibility criteria.

Purpose of the Study:

• To develop a diagnostic algorithm utilizing electrodiagnostic (EDX) studies to determine eligibility for nerve transfer surgery in SCI patients.
• To investigate candidacy for nerve transfer surgery in patients with cervical SCI, irrespective of the time elapsed since injury.

Main Methods:

• A retrospective descriptive case series was conducted at a tertiary university-based institution.
• Medical records of 45 individuals with cervical SCI referred for upper extremity surgery were reviewed.
• Electrodiagnostic data, including nerve conduction studies and electromyography, were analyzed to assess for lower motor neuron injury, a contraindication for late nerve transfer.

Main Results:

• A significant number of patients, even those years post-SCI, met the criteria for nerve transfer eligibility based on EDX testing.
• Clinical outcomes, while heterogeneous, showed promising results, indicating potential for functional restoration.
• The study highlights the need for refined eligibility criteria, long-term follow-up, and standardized assessments.

Conclusions:

• Many individuals living with SCI are candidates for nerve transfer surgery to regain upper extremity function.
• While efficacy requires further determination, the study provides criteria for intervention timing and transfer selection in this heterogeneous population.