Nerve Transfers for Cervical Spine Pathology: Restoring Shoulder and Elbow Function for C5 Nerve Root Palsy

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Peripheral Nerve Surgery

Background:

• Cervical radiculopathy often necessitates decompressive surgery, with a notable percentage of patients experiencing postoperative motor dysfunction.
• Nerve transfers are explored as a treatment for persistent motor deficits stemming from cervical spine pathologies.

Purpose of the Study:

• To evaluate the effectiveness of peripheral nerve transfers in treating upper-extremity motor weakness caused by cervical spine conditions.
• To assess nerve transfers for postoperative palsy and radiculopathy refractory to conventional surgical treatments.

Main Methods:

• A retrospective case series analyzed 8 patients undergoing peripheral nerve transfer for cervical spine-related motor palsy.
• Data included 5 cases of postoperative palsy and 3 cases of radiculopathy, with outcomes assessed via chart review of physical exams.

Main Results:

• Significant motor strength recovery was observed post-transfer, with 6/8 patients achieving at least M3 shoulder abduction strength.
• Improvement in elbow flexion was noted in most patients (6/7), with 5 achieving M4 strength.
• Earlier intervention (6-7 months from symptom onset) correlated with better outcomes.

Conclusions:

• Peripheral nerve transfer is a promising surgical option for persistent upper-extremity motor weakness due to cervical spine issues.
• Timely referral for nerve transfer is crucial when spontaneous recovery is unlikely, requiring collaboration between spine and upper-extremity surgeons.