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

An estimated one in four cases of cervical radiculopathy will indicate decompressive surgery. Around 7% of patients will develop motor dysfunction following such procedures. This study aims to demonstrate the utility of nerve transfers for cervical spine pathologies, including postoperative palsy and cervical radiculopathy with motor dysfunction refractory to decompressive surgery.

This study represents a retrospective case series of peripheral nerve transfer for palsy of cervical spine etiology at a single institution. A CPT code query was used to identify all cases of nerve transfer, and instances where the transfer was performed for cervical spine pathology were manually identified from this list. The identified cohort consisted of 8 patients: 5 cases of postoperative palsy and 3 cases of radiculopathy. Preoperative and postoperative physical exam results were gathered via chart review.

Postoperatively, 6/8 cases resulted in at least M3 strength in shoulder abduction, with 4 instances of M4 function or better by final follow-up. All but 1 patient showed improvement in elbow flexion following nerve transfer, with 5/7 patients showing at least M4 function by final follow-up. Patients who underwent nerve transfer within 6 to 7 months of symptom onset appeared to experience superior results.

Peripheral nerve transfer represents a viable treatment option for patients demonstrating upper-extremity motor weakness of cervical spine etiology lasting greater than 4 to 5 months without significant improvement. Coordination between spine and upper-extremity surgeons should serve to optimize outcome through timely referral for nerve transfer once spontaneous recovery appears unlikely.