Nerve and Tendon Transfers for Upper Extremity Reconstruction in Spinal Cord Injury Patients: A Systematic Review

Area of Science:

• Orthopedics
• Neurosurgery
• Rehabilitation Medicine

Background:

• Spinal cord injury (SCI) frequently causes upper extremity paralysis, diminishing patient independence.
• Surgical options like nerve and tendon transfers can restore hand grasp and elbow extension.
• Limited utilization of these effective surgical techniques necessitates further review.

Purpose of the Study:

• To systematically review clinical outcomes of nerve and tendon transfers for upper extremity reconstruction in cervical SCI patients.
• To synthesize evidence on the efficacy of surgical interventions for functional restoration after SCI.
• To identify common transfer techniques and their associated outcomes.

Main Methods:

• Systematic literature search across major databases (PubMed, Scopus, Embase, Web of Science) adhering to PRISMA guidelines.
• Inclusion of studies reporting quantitative outcomes for nerve or tendon transfers in SCI patients.
• Descriptive synthesis of data due to heterogeneity; risk of bias assessed using Newcastle-Ottawa Scale.

Main Results:

• Thirty studies involving 568 patients and 766 limbs were included (15 nerve, 15 tendon transfers).
• Common nerve transfers included brachialis to anterior interosseous nerve (AIN); common tendon transfers involved extensor carpi radialis longus (ECRL) to flexor digitorum profundus (FDP).
• Both techniques yielded significant functional gains, with nerve transfers offering better biomechanics and tendon transfers providing greater strength; early rehabilitation was beneficial.

Conclusions:

• Nerve and tendon transfers are effective surgical strategies for improving upper limb function in cervical SCI.
• These reconstructive procedures offer substantial functional restoration, positively impacting quality of life.
• Further research and clinical application of these techniques are warranted.