Upper Extremity Surgery in Cervical Spinal Cord Injury: A Prospective Comparative Mixed-Methods Study.

Area of Science:

• Neurosurgery
• Rehabilitation Medicine
• Spinal Cord Injury Research

Background:

• Cervical spinal cord injury (SCI) severely impacts patient independence and quality of life.
• Restoration of upper extremity function is a primary goal for SCI patients.
• Tendon transfer (TT) and nerve transfer (NT) are surgical options for functional restoration.

Purpose of the Study:

• To prospectively compare long-term upper extremity functional changes in cervical SCI patients.
• To evaluate outcomes between surgical (TT or NT) and nonsurgical management.
• To utilize a mixed-methods approach for comprehensive assessment.

Main Methods:

• A multicenter cohort study design comparing three groups: no surgery, TT surgery, and NT surgery.
• Quantitative data collected using the Spinal Cord Independence Measure (SCIM) and SF-36 Health Survey at baseline and 6-24 months.
• Qualitative data from semistructured interviews with participants and caregivers at multiple time points.

Main Results:

• SCIM scores demonstrated significant improvement in both TT and NT groups versus the no-surgery group (P < 0.05).
• No significant differences were observed in SF-36 scores among the groups.
• Qualitative data confirmed functional gains in activities of daily living, transfers, and specialized tasks like operating electronics or a motor vehicle.

Conclusions:

• TT and NT surgeries result in significant quantitative and qualitative functional improvements for cervical SCI patients.
• Postoperative therapy is crucial for maximizing functional gains.
• This comparative data can aid surgeons in discussing treatment options with patients.