Reconstruction of paralyzed arm function in patients with hemiplegia through contralateral seventh cervical nerve cross transfer: a multicenter study and real-world practice guidance

Abstract

Background A previous randomized controlled trial showed contralateral seventh cervical nerve (CC7) cross transfer to be safe and effective in restoring the arm function of spastic arm paralysis patients in a specified population. Guidance on indications, safety and expected long-term improvements of the surgery are needed for clinical practice.Methods This is a retrospective, multicenter, propensity score-matched cohort study. All patients registered between 2013 and 2019 with unilateral spastic arm paralysis over 1 year who were registered at one of five centers in China and South Korea were included. Patients received CC7 cross transfer or rehabilitation treatment in each center. Primary outcome was the change in the upper-extremity Fugl−Meyer (UEFM) score from baseline to 2-year follow-up; larger increase indicated better functional improvements.

Crossing nerve transfer drives sensory input–dependent plasticity for motor recovery after brain injury

“…Comparing with other models, such as pyramidotomy lesion, we believe that TBI can better simulate the pathological state after unilateral cortical lesion and contribute to research the remolding of contralesional hemisphere better ( 33 ). However, clinical studies have confirmed that CC7 surgery has good effects on patients with hemiplegia caused by various diseases ( 7 , 34 ), the CST changes in various disease models of different species need to be evaluated in future study.…”

Site of Nerve Division Affects Pain-Related Behavior and Spinal Cord Glial Proliferation after C7 Neurotomy in a Rat Stroke Model

“…Contralateral C7 nerve transfer has been applied to improve upper limb spastic paralysis after stroke and has achieved good outcomes in terms of releasing spasticity, enhancing muscle strength, and improving voluntary motion coordination [ 5 – 7 ]. The procedure involves sectioning of the C7 nerve at the intervertebral foramen on the paralyzed side, which results in neuropathic pain [ 6 , 7 ]. We hypothesized that nerve division so close to the spinal cord is the crucial factor.…”

“…A new surgical strategy, contralateral C7 nerve transfer, has been introduced to improve upper limb function in stroke patients with upper limb spastic paralysis. This technique involves transferring the C7 nerve from the contralateral (nonparalyzed) side to the paralyzed side and has achieved considerable improvements in functional outcomes [ 4 – 7 ]. During the operation, the contralateral C7 nerve is sectioned as distally from the spinal cord as possible but proximal to the point at which it combines with other nerves; the ipsilateral C7 nerve (paralyzed side) is sectioned at the intervertebral foramen.…”

“…Then, the contralateral C7 nerve is drawn through the prespinal route to the paralyzed side and anastomosed directly with the ipsilateral C7 nerve root [ 8 , 9 ]. However, between 58% and 72% of patients experience neuropathic pain in the paralyzed upper limb after surgery [ 6 , 7 ]. One cause of this pain may be C7 neurotomy, as many patients experience neuropathic pain after peripheral nerve injury that is characterized by spontaneous pain and mechanical and thermal allodynia.…”

Improvement of language function after C7 neurotomy at the intervertebral foramen in patients with chronic post-stroke aphasia: a phase I cohort study

“…We previously proposed that contralateral C7 transfer from the nonparalyzed side to the paralyzed side (contralateral C7 to C7 cross nerve transfer [CC7]) can effectively improve upper limb function [10, 11]. In the clinical follow-up of this surgery, post-stroke patients with complicated chronic aphasia surprisingly showed improvement in self-reported language function, not only in terms of fluency but also in terms of increased naming ability.…”