Nerve transfers in tetraplegia: a review and practical guide

Emamhadi, Mohammadreza; Dogahe, Mohammad Haghani; Gohritz, Andreas

doi:10.23736/s0390-5616.21.05312-1

Cited by 6 publications

(8 citation statements)

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“…Much of the literature on this topic consists of case reports and retrospective case series limited by small sample sizes. 31 , 32 Previous studies used nonstandardized assessments, and substantial heterogeneity in outcomes precluded the quantitative synthesis of existing data. 31 , 33 In addition, long-term postoperative data are lacking on nerve transfers in tetraplegia.…”

Section: Discussionmentioning

confidence: 99%

“…A lack of rigorous evidence remains for the clinical utility of nerve transfers in tetraplegia. Much of the literature on this topic consists of case reports and retrospective case series limited by small sample sizes . Previous studies used nonstandardized assessments, and substantial heterogeneity in outcomes precluded the quantitative synthesis of existing data .…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Upper Limb Nerve Transfer Surgery in Patients With Tetraplegia

et al. 2022

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“…No improvement of MUPs at 4 to 6 months or reduced units with strength would be considered a poor predictor for long-term outcomes. In this situation, peripheral nerve transfer should be offered to patients sooner 1–3…”

Section: Management Of Motor Palsy After Cervical Spine Surgerymentioning

confidence: 99%

Surgical Management of Iatrogenic Nerve Root Palsy: Cervical Root

Emamhadi,

Alijani,

Dogahe

et al. 2023

Contemporary Neurosurgery

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Management of permanent iatrogenic cervical nerve root palsy is a challenge faced by spine surgeons. Reconstructive surgery using nerve transfer has shown great hope in restoring somatosensory injuries such as iatrogenic cervical nerve root palsy. Nerve transfer is justified by using less important donor nerves to regain major function. Nerve transfers are cost-effective procedures increasingly used to treat central and peripheral nervous system injuries. This article provides a comprehensive reanimation strategy to restore lost functions after iatrogenic cervical nerve root palsy. After reading this article, the trainers should explain the importance of surgical reconstruction after iatrogenic cervical nerve root palsy; they should manage preoperative assessments, address various nerve transfers based on the level of injury and pattern of paralysis, and plan for postoperative rehabilitation strategy.

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“…PNT has been newly performed for the restoration of limb function in patients with spinal cord injury, which leads to similar functional improvements in those treated with a tendon transfer [ 3 , 4 , 6 , 90 ]. The surgical procedure for performing nerve transfer should be based on the functional level of spinal cord injury and the individual's needs [ 100 ]. Meanwhile, contralateral C7 nerve transfer from the nonparalyzed side to the paralyzed side has been creatively performed in patients with chronic cerebral injury to ameliorate the spasticity of the affected upper limb, and satisfactory motor functional improvement has been obtained during the one-year follow-up [ 101 ].…”

Section: The New Application Of Pnt and The Modulation Of Neuroplasti...mentioning

confidence: 99%

Plasticity of the Central Nervous System Involving Peripheral Nerve Transfer

Shen¹

2022

Neural Plasticity

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Peripheral nerve injury can lead to partial or complete loss of limb function, and nerve transfer is an effective surgical salvage for patients with these injuries. The inability of deprived cortical regions representing damaged nerves to overcome corresponding maladaptive plasticity after the reinnervation of muscle fibers and sensory receptors is thought to be correlated with lasting and unfavorable functional recovery. However, the concept of central nervous system plasticity is rarely elucidated in classical textbooks involving peripheral nerve injury, let alone peripheral nerve transfer. This article is aimed at providing a comprehensive understanding of central nervous system plasticity involving peripheral nerve injury by reviewing studies mainly in human or nonhuman primate and by highlighting the functional and structural modifications in the central nervous system after peripheral nerve transfer. Hopefully, it will help surgeons perform successful nerve transfer under the guidance of modern concepts in neuroplasticity.

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Nerve transfers in tetraplegia: a review and practical guide

Cited by 6 publications

References 50 publications

Upper Limb Nerve Transfer Surgery in Patients With Tetraplegia

Upper Limb Nerve Transfer Surgery in Patients With Tetraplegia

Surgical Management of Iatrogenic Nerve Root Palsy: Cervical Root

Plasticity of the Central Nervous System Involving Peripheral Nerve Transfer

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