Expanding traditional tendon-based techniques with nerve transfers for the restoration of upper limb function in tetraplegia: a prospective case series

Zyl, Natasha van; Hill, Bridget; Cooper, Catherine A.; Hahn, Jodie; Galea, Mary P.

doi:10.1016/s0140-6736(19)31143-2

Cited by 111 publications

(120 citation statements)

References 25 publications

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“…Mean time to surgery was 19 months (range 4–144). The three largest series, representing 32 of the 51 patients, had means of 7.7, 8.6 and 10.7 months to surgery (Bertelli and Ghizoni, 2015, 2017; van Zyl et al., 2019). Mean time to follow-up was 19 months (range 5–34).…”

Section: Resultsmentioning

confidence: 99%

“…Of the 37 limbs with a nerve transfer for elbow extension, seven were graded as less than MRC Grade 3 (Table 3) (Bertelli and Ghizoni, 2013, 2015; Bertelli et al., 2011; Fox et al., 2015; Sananpanich et al., 2018; van Zyl et al., 2014, 2019). Of these, six cases were classified as AIS C4 immediately after their injury (van Zyl et al., 2019). The seventh patient was 47 years old, AIS C6 and followed-up at 11 months, graded as 2 (Fox et al., 2015).…”

Section: Resultsmentioning

confidence: 99%

“…Forty-eight S-PIN transfers have been reported since its first documentation by Bertelli in 2010 (Bertelli and Ghizoni, 2013, 2015, 2016; Bertelli et al., 2010; Emamhadi and Andalib, 2018; Sananpanich et al., 2018; van Zyl et al., 2014, 2019). For cases with a reported ICSHT group, two belonged to Group 1, nine to Group 2, eight to Group 3, eight to Group 4 and six to Group 5.…”

Section: Resultsmentioning

confidence: 99%

“…We also included a trial from the Australia and New Zealand Clinical Trial Registry as it presented the highest number of transfers and prospectively gathered data on clinical and functional outcome at the time of the literature review. This report was subsequently accepted for publication (van Zyl et al., 2019). The final number of articles analysed was 17.…”

Section: Methodsmentioning

confidence: 98%

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Evidence for efficacy of new developments in reconstructive upper limb surgery for tetraplegia

Ledgard

Gschwind

2019

J Hand Surg Eur Vol

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Nerve transfers are increasingly utilized for upper limb reconstruction in tetraplegia. We reviewed the literature for results achieved by nerve transfers for elbow extension, wrist control and finger and thumb flexion and extension. Muscle strength grading was the only outcome measure consistently reported. The results confirm that nerve transfers can effectively reanimate muscles in selected cases, with comparable strength with those achieved with tendon transfer for elbow extension but inferior strength for finger and thumb flexion. Transfer of supinator nerve branches to the posterior interosseous nerve appears to be reliable and offers increased span and better hand opening than is observed after tendon transfers. Only one publication demonstrated how reinnervation of muscles with nerve transfers translated into improved function, activity and participation for patients. More prospective studies, using standardized outcome measures, are needed to define the precise role of nerve transfers.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 98%

See 2 more Smart Citations

Evidence for efficacy of new developments in reconstructive upper limb surgery for tetraplegia

Ledgard

Gschwind

2019

J Hand Surg Eur Vol

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“…Hence, although nonurgent, these pathological entities are, however, time dependent. Poor timing will compromise the degree of neurological recovery 8 and, consequently, the possibility of decreasing the degree of assistance required by these patients, with important repercussions on their quality of life and the amount of assistance, societal costs, and public expenditure to be invested. 9 In addition, patients who have experienced a better and faster neurological recovery will be more satisfied and will need less assistance, decreasing the global societal cost required to manage their disability.…”

mentioning

confidence: 99%

Letter to the Editor Regarding “Opinion Piece: Microsurgery in COVID-19–Positive Patients”

et al. 2020

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Upper Limb Nerve Transfer Surgery in Patients With Tetraplegia

et al. 2022

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ImportanceCervical spinal cord injury (SCI) causes devastating loss of upper extremity function and independence. Nerve transfers are a promising approach to reanimate upper limbs; however, there remains a paucity of high-quality evidence supporting a clinical benefit for patients with tetraplegia.ObjectiveTo evaluate the clinical utility of nerve transfers for reanimation of upper limb function in tetraplegia.Design, Setting, and ParticipantsIn this prospective case series, adults with cervical SCI and upper extremity paralysis whose recovery plateaued were enrolled between September 1, 2015, and January 31, 2019. Data analysis was performed from August 2021 to February 2022.InterventionsNerve transfers to reanimate upper extremity motor function with target reinnervation of elbow extension and hand grasp, pinch, and/or release.Main Outcomes and MeasuresThe primary outcome was motor strength measured by Medical Research Council (MRC) grades 0 to 5. Secondary outcomes included Sollerman Hand Function Test (SHFT); Michigan Hand Outcome Questionnaire (MHQ); Disabilities of Arm, Shoulder, and Hand (DASH); and 36-Item Short Form Health Survey (SF-36) physical component summary (PCS) and mental component summary (MCS) scores. Outcomes were assessed up to 48 months postoperatively.ResultsTwenty-two patients with tetraplegia (median age, 36 years [range, 18-76 years]; 21 male [95%]) underwent 60 nerve transfers on 35 upper limbs at a median time of 21 months (range, 6-142 months) after SCI. At final follow-up, upper limb motor strength improved significantly: median MRC grades were 3 (IQR, 2.5-4; P = .01) for triceps, with 70% of upper limbs gaining an MRC grade of 3 or higher for elbow extension; 4 (IQR, 2-4; P &lt; .001) for finger extensors, with 79% of hands gaining an MRC grade of 3 or higher for finger extension; and 2 (IQR, 1-3; P &lt; .001) for finger flexors, with 52% of hands gaining an MRC grade of 3 or higher for finger flexion. The secondary outcomes of SHFT, MHQ, DASH, and SF36-PCS scores improved beyond the established minimal clinically important difference. Both early (&lt;12 months) and delayed (≥12 months) nerve transfers after SCI achieved comparable motor outcomes. Continual improvement in motor strength was observed in the finger flexors and extensors across the entire duration of follow-up.Conclusions and RelevanceIn this prospective case series, nerve transfer surgery was associated with improvement of upper limb motor strength and functional independence in patients with tetraplegia. Nerve transfer is a promising intervention feasible in both subacute and chronic SCI.

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Expanding traditional tendon-based techniques with nerve transfers for the restoration of upper limb function in tetraplegia: a prospective case series

Cited by 111 publications

References 25 publications

Evidence for efficacy of new developments in reconstructive upper limb surgery for tetraplegia

Evidence for efficacy of new developments in reconstructive upper limb surgery for tetraplegia

Letter to the Editor Regarding “Opinion Piece: Microsurgery in COVID-19–Positive Patients”

Upper Limb Nerve Transfer Surgery in Patients With Tetraplegia

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