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Updated: Jan 9, 2026

Vascularized Composite Upper Limb Allograft Harvesting for Proximal Arm Allotransplantation
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Upper Extremity Reconstruction in Patients With Cervical Spinal Cord Injury.

Rachana Suresh1, Mohammed Shahid1, Anirudh Buddhiraju1

  • 1Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Hand (New York, N.Y.)
|December 1, 2025
PubMed
Summary
This summary is machine-generated.

Upper extremity reconstruction (UER) is crucial for cervical spinal cord injury (SCI) patients, yet less than 1% undergo these procedures. Tendon procedures are more common than nerve procedures for restoring function and managing spasticity.

Keywords:
cervical spinal cord injurynerve transfertendon transfertetraplegiaupper extremity reconstruction

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Area of Science:

  • Orthopedics
  • Neurosurgery
  • Rehabilitation Medicine

Background:

  • Restoring hand and upper extremity function is a priority for cervical spinal cord injury (SCI) patients.
  • Upper extremity reconstruction (UER) offers functional restoration but is underutilized.
  • This study investigates the incidence and timing of UER in cervical SCI patients.

Purpose of the Study:

  • To evaluate the utilization rates of upper extremity reconstructive procedures in patients with cervical SCI.
  • To analyze the timing of these procedures post-injury.
  • To compare patient characteristics between those who received UER and those who did not.

Main Methods:

  • The TriNetX Research Network database was queried for patients with cervical SCI.
  • Procedures for motor restoration and spasticity management were identified using ICD-10, CPT, and SNOMED codes.
  • Propensity score-matched analysis compared UER rates across demographic groups.

Main Results:

  • Only 0.8% of cervical SCI patients underwent UER, with higher rates in low cervical (C5-C8) and complete injuries.
  • Tendon/joint procedures were more frequent than nerve procedures for both motor restoration and spasticity.
  • Nerve transfers were performed earlier post-injury than tendon procedures. Patients receiving UER were younger, more likely to have complete SCI, and had higher psychiatric comorbidity rates.

Conclusions:

  • Under 1% of cervical SCI patients receive UER, with a higher proportion of tendon procedures over nerve procedures.
  • White patients and males were more likely to receive nerve-related UER procedures.
  • UER utilization remains low despite its functional importance for cervical SCI patients.