Contralateral cervical seventh nerve transfer for spastic arm paralysis via a modified prespinal route: a cadaveric study

Li, Peiyang; Shen, Yun-Dong; Xu, Jing; Liang, Chunmin; Su, Jian; Qiu, Yan‐Qun; Yin, Hongyan; Feng, Juntao; Li, Tie; Shen, Jun; Wang, Guobao; Yu, Bao‐Fu; Ye, Xuan; Yu, Ai-Ping; Lei, Gaowei; Cai, Zeyu; Xu, Wendong

doi:10.1007/s00701-019-04069-y

Cited by 11 publications

(5 citation statements)

References 13 publications

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“…Cutting the C7 nerve on the paralyzed side may alleviate spasticity and improve arm function by releasing gamma motor neurons. This approach, crossing peripheral nerve pathways for chronic brain injury treatment, involves severing bilateral C7 nerves and rerouting the intact side’s C7 nerve to the paralyzed side, offering a strategic method for restoring arm function 44 , 45 , 72 …”

Section: Discussionmentioning

confidence: 99%

Peripheral nerve transfers for dysfunctions in central nervous system injuries: a systematic review

Xiang,

Wu,

et al. 2024

International Journal of Surgery

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Background: The review highlights recent advancements and innovative uses of nerve transfer surgery in treating dysfunctions caused by central nervous system (CNS) injuries, with a particular focus on spinal cord injury (SCI), stroke, traumatic brain injury, and cerebral palsy. Methods: A comprehensive literature search was conducted regarding nerve transfer for restoring sensorimotor functions and bladder control following injuries of spinal cord and brain, across PubMed and Web of Science from January 1920 to May 2023. Two independent reviewers undertook article selection, data extraction, and risk of bias assessment with several appraisal tools, including the Cochrane Risk of Bias Tool, the JBI Critical Appraisal Checklist, and SYRCLE’s ROB tool. The study protocol has been registered and reported following PRISMA and AMSTAR guidelines. Results: Nine hundred six articles were retrieved, of which 35 studies were included (20 on SCI and 15 on brain injury), with 371 participants included in the surgery group and 192 in the control group. These articles were mostly low-risk, with methodological concerns in study types, highlighting the complexity and diversity. For SCI, the strength of target muscle increased by 3.13 of Medical Research Council grade, and the residual urine volume reduced by more than 100 ml in 15 of 20 patients. For unilateral brain injury, the Fugl-Myer motor assessment (FMA) improved 15.14–26 score in upper extremity compared to 2.35–26 in the control group. The overall reduction in Modified Ashworth score was 0.76–2 compared to 0–1 in the control group. Range of motion (ROM) increased 18.4–80° in elbow, 20.4–110° in wrist and 18.8–130° in forearm, while ROM changed −4.03°−20° in elbow, −2.08°−10° in wrist, −2.26°−20° in forearm in the control group. The improvement of FMA in lower extremity was 9 score compared to the presurgery. Conclusion: Nerve transfer generally improves sensorimotor functions in paralyzed limbs and bladder control following CNS injury. The technique effectively creates a ‘bypass’ for signals and facilitates functional recovery by leveraging neural plasticity. It suggested a future of surgery, neurorehabilitation and robotic-assistants converge to improve outcomes for CNS.

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Section: Discussionmentioning

confidence: 99%

Peripheral nerve transfers for dysfunctions in central nervous system injuries: a systematic review

Xiang,

Wu,

et al. 2024

International Journal of Surgery

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“…Given currently dissatis ed outcomes and large HICH populations, we need additional intervention to limb hemiplegia [32][33][34][35].Rationales behind the previous C7-to-C7 transfer for the paretic upper limb are beginning to be accepted and understood as scalability [36][37][38][39][40].Reinnervation of the denervated muscles,γ-circuit interruption,and establishing a new pathway remarkably contributed to a motor recovery post-transfer [41,42]. Contralateral lumbar neurotization engaging the similar mechanisms was considered available for a lower limb paresis after central neurological injury.Thus,in this project,we would rather extend the L4-to-L4 transfer to hindlimb hemiplegia than other transfer modalities in rats.…”

Section: Discussionmentioning

confidence: 99%

Customized Neurotization for Hindlimb Hemiplegia After a Hemorrhagic Stroke

Qian

Zheng

Shi

et al. 2020

Preprint

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Background Hemiplegia after hypertensive intracerebral hemorrhage(HICH) is prevalent,devasta-ting,and currently unable to intervene satisfactorily.Established success in neurotization spurs our interest in restoring skilled lower-limb movement.Here,we explored whether contralesional L4 transfer to ipsilesional L4 root,featuring simultaneous invigoration of flexors and extensors,reanimated dexterous locomotion for the hemiplegic hindlimb after HICH.Methods We manufactured eligible rat models by injecting autologous vein blood into the left posterior limb of internal capsule (PLIC) and randomized thirty rats into three groups. We did not transect but expose bilateral L4 in group A (sham operation) after injection of saline,and infused equal blood followed by bilateral L4 transection and contralateral L4 transfer,in group B and group C,respectively.Behavioral,ultrastru-ctural,immunofluorescent,and electromyographic assessments were applied to efficacy analysis.MRI localized the PLIC impact.Results We could see marked reduction in movements and capture a denervated potential in the right hindlimb of model rats (P༞0.05).In the walking tests,group C exhibited an initially high slip,but,later, a larger increment in accuracy on the paretic side, compared to group B and group A(P༜0.001).Also,at Week 17,rats gained ∼58.2% accuracy and actuated ankle motions in group C(P༞0.05). In the retrograde tracing,at Week 9,fluoro-gold labeled motoneurons had been numerously present in the left anterior horn of the spinal cord from the L4-to-L4 root.Histological and ultra-microstructural assessments certified efficient axons regeneration.Electrom-yography and pawprint analysis implied the denervated muscles were reliably reinnervated,and myodynamia improvement(p>0.05).Conclusions Contralateral L4 transfer could render favorable outcomes for major joints,particularly for the ankle,therefore efficaciously repaired the hemiplegic hindlimb after HICH.

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“…All methods were in accordance with the relevant guidelines and regulations of Suining Central Hospital Surgical Procedures: All surgical procedures in our hospital utilize the anterior cervical approach, with each of the 14 surgeries performed by the same chief physician. Our surgical approach is primarily based on the Huashan Hospital's anterior cervical approach protocol [9]. Prior to surgery, clearly mark the healthy side with "YES" and the affected side with "NO".…”

Section: Methodsmentioning

confidence: 99%

Clinical efficacy analysis of the treatment of central hemiplegia with cervical nerve 7 displacement via anterior cervical approach under microscope

Xiang,

Shi,

et al. 2024

Preprint

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Objective: To investigate the clinical effectiveness and prognosis of contralateral C7 nerve transfer via the anterior cervical approach in the treatment of central hemiplegia. Method: The clinical data of patients with central hemiplegia admitted to the Neurosurgery Department of Suining Central Hospital between 2022 and 2023 were retrospectively analyzed. All cases were categorized into an experimental group and a control group. The experimental group comprised patients who underwent cervical 7 nerve transfer surgery; The control group included patients who received physical rehabilitation therapy during the same period and matched the age and general conditions of the surgical patients. The rehabilitation progress of the surgical and physical rehabilitation groups was compared at three time points: before treatment, six months post-treatment, and twelve months post-treatment. Indicators collected included: Modified Ashworth Scale (MAS) grades to assess muscle tone in the affected limbs; Fugl-Meyer Motor Function Assessment (FMA) scores to evaluate upper limb motor function; Berg Balance Scale (BBS) scores to assess balance function; and Boston Diagnostic Aphasia Examination (BDAE) grades to evaluate language function. Statistical Analysis: Data were analyzed using SPSS 25.0 statistical software. Repeated measures analysis of variance was applied for the Fugl–Meyer, BDAE, and BBS scores, while independent sample t-tests were used for comparing the two groups at the same time point. Bonferroni tests were applied for pair-wise comparisons between the same group at different time points. Mann-Whitney tests were used for the MAS scores. Differences were considered statistically significant with P<0.05. All methods were in accordance with the relevant guidelines and regulations of Suining Central Hospital Result:All surgical patients successfully completed their procedures, with an average duration of approximately 6 hours. Postoperatively, the unaffected limbs exhibited varying degrees of pain, yet their movement remained within normal limits. There were no complications including wound infections or bleeding in the surgical areas. The Fugl-Meyer assessment scale revealed significant improvements in motor function for both the surgical and physical rehabilitation groups, with the surgical group outperforming the physical rehabilitation group, especially in terms of upper limb stiffness and movement (p＞0.05); Conclusion: This study demonstrates that CC7 nerve cross transfer surgery effectively, safely, and sustainably improves spasticity, balance, and upper limb motor function in patients with unilateral spastic arm paralysis, without significant contralateral limb dysfunction or serious complications. The high clinical efficacy and safety of the procedure provide a basis for expanding its indications to a broader population of hemiplegic patients. The primary limitation of this study is its retrospective design, with selection biases and potential confounding factors persisting even after closely matching key characteristics. Consequently, the findings should be interpreted with caution. Additional multicenter studies are warranted to further assess its effectiveness and safety.

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Contralateral cervical seventh nerve transfer for spastic arm paralysis via a modified prespinal route: a cadaveric study

Cited by 11 publications

References 13 publications

Peripheral nerve transfers for dysfunctions in central nervous system injuries: a systematic review

Peripheral nerve transfers for dysfunctions in central nervous system injuries: a systematic review

Customized Neurotization for Hindlimb Hemiplegia After a Hemorrhagic Stroke

Clinical efficacy analysis of the treatment of central hemiplegia with cervical nerve 7 displacement via anterior cervical approach under microscope

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