Nerve transfers for elbow and finger extension reconstruction in midcervical spinal cord injuries

Bertelli, Jayme Augusto; Ghizoni, Marcos Flávio

doi:10.3171/2014.8.jns14277

Cited by 78 publications

(91 citation statements)

References 19 publications

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“…In adult upper brachial plexus injuries, nerve transfers were found to be more effective at restoring elbow flexion and shoulder abduction when compared to nerve grafting [70]. Recently, the use of nerve transfers has been widened to include repair of cervical spine injuries, ulnar and radial nerve injuries in the upper extremity, femoral nerve injuries in the lower extremity, and many more [71,72,73,74]. Current indications for nerve transfer include proximal nerve root avulsion, high peripheral nerve injuries, trauma with significant scarring at site of injury, and with large neuromas in-continuity and/or with multilevel injuries [75].…”

Section: Building a Case For Combined Peripheral Nerve Transfer Anmentioning

confidence: 99%

Peripheral Nerve Injury: Stem Cell Therapy and Peripheral Nerve Transfer

Sullivan

Dailey

Duncan

et al. 2016

IJMS

181

122

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Peripheral nerve injury can lead to great morbidity in those afflicted, ranging from sensory loss, motor loss, chronic pain, or a combination of deficits. Over time, research has investigated neuronal molecular mechanisms implicated in nerve damage, classified nerve injury, and developed surgical techniques for treatment. Despite these advancements, full functional recovery remains less than ideal. In this review, we discuss historical aspects of peripheral nerve injury and introduce nerve transfer as a therapeutic option, as well as an adjunct therapy to transplantation of Schwann cells and their stem cell derivatives for repair of the damaged nerve. This review furthermore, will provide an elaborated discussion on the sources of Schwann cells, including sites to harvest their progenitor and stem cell lines. This reflects the accessibility to an additional, concurrent treatment approach with nerve transfers that, predicated on related research, may increase the efficacy of the current approach. We then discuss the experimental and clinical investigations of both Schwann cells and nerve transfer that are underway. Lastly, we provide the necessary consideration that these two lines of therapeutic approaches should not be exclusive, but conversely, should be pursued as a combined modality given their mutual role in peripheral nerve regeneration.

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Section: Building a Case For Combined Peripheral Nerve Transfer Anmentioning

confidence: 99%

Peripheral Nerve Injury: Stem Cell Therapy and Peripheral Nerve Transfer

Sullivan

Dailey

Duncan

et al. 2016

IJMS

181

122

View full text Add to dashboard Cite

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“…Nerve transfers have reliably restored thumb and finger extension when the nerve to the supinator is transferred to the PIN, with 1 partial failure in 21 treated patients with spinal cord or brachial plexus palsy. 3,7,38 However, in radial nerve palsy, the nerve to the supinator muscle is paralyzed and unavailable for transfer. The question is not whether nerve transfers provide reliable results for thumb and finger extension reconstruction, but whether the FCR is the best donor nerve.…”

Section: And Fdsmentioning

confidence: 99%

Results of nerve grafting in radial nerve injuries occurring proximal to the humerus, including those within the posterior cord

Bertelli¹,

Ghizoni²

2016

JNS

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T he radial nerve innervates muscles responsible for elbow, wrist, and thumb/finger extension, with triceps innervation originating high in the axilla. 8 We define proximal lesions of the radial nerve as injuries proximal to the humerus, including lesions within the posterior cord. All patients present with paralysis of wrist, thumb, and finger extension. Elbow extension is either preserved or not, depending on whether the site of injury is proximal or distal to the latissimus dorsi tendon where the first branch to the triceps-which innervates the triceps long head-originates.Radial nerve grafting has been associated with good results. However, the initial excellent results obtained by Millesi 23 have not been reproduced in other series. 24 On the British Medical Research Council (BMRC) scale, Millesi 23 obtained an M5 level of recovery in 43% of his 38 patients. Recent series of radial nerve grafting at the arm level have generated variable outcomes, but less than ideal results. 1,6,26,31,34,37 If, on the one hand, a large body of literature is available documenting the results of radial nerve grafting at the arm level, on the other hand, results of grafting for proximal lesions are largely unknown. Proximal injuries of the radial nerve are associated with high-energy trauma and humeral fractures, portending worse outcomes. 20,30Very few reports have addressed proximal lesions of the radial nerve, 26,31,34 and none have separated postgraft strength recovery results for elbow, wrist and finger extension.In the present paper, we report the outcomes in a series of 13 consecutive patients with proximal lesions of the radial nerve who underwent reconstructive surgery over a 3-year period. MethodsBetween 2009 and 2012, 13 male patients with a mean age of 26 years (range 17-37 years), all with proximal radial nerve lesions as a result of a motorcycle accident, underwent surgery at our institution at a mean of 6 months postinjury (range 4-9 months). Among these 13 patients, 7 had bone injuries. Among those without fractures, 2 had obJective Results of radial nerve grafting are largely unknown for lesions of the radial nerve that occur proximal to the humerus, including those within the posterior cord. Methods The authors describe 13 patients with proximal radial nerve injuries who were surgically treated and then followed for at least 24 months. The patients' average age was 26 years and the average time between accident and surgery was 6 months. Sural nerve graft length averaged 12 cm. Recovery was scored according to the British Medical Research Council (BMRC) scale, which ranges from M0 to M5 (normal muscle strength). results After grafting, all 7 patients with an elbow extension palsy recovered elbow extension, scoring M4. Six of the 13 recovered M4 wrist extension, 6 had M3, and 1 had M2. Thumb and finger extension was scored M4 in 3 patients, M3 in 2, M2 in 2, and M0 in 6. coNclusioNs The authors consider levels of strength of M4 for elbow and wrist extension and M3 for thumb and finger extension to be good res...

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“…The limitations of tendon transfers include limited tendon/muscle donors and a long duration of postoperative immobilization. Newer treatment options such as nerve transfer surgery [1][2][3][5][6][7][8][9][10][11][12][13] could improve eligibility or desirability for reconstructive surgery.…”

Section: Introductionmentioning

confidence: 99%