Spontaneous Motor Recovery after Cervical Spinal Cord Injury: Issues for Nerve Transfer Surgery Decision Making

Dengler, Jana; Steeves, John D.; Curt, Armin; Mehra, Munish; Novak, Christine B.; Curtin, Catherine; Kennedy, Carie R.; Ota, Doug; Stenson, Katherine C.; Maier, Doris; Abel, Rainer; Weidner, Norbert; Rupp, Rüdiger; Vidal, Joan; Benito, Juana Gómez; Kalke, Yorck-Bernhard; Fox, Ida K.

doi:10.1038/s41393-022-00834-6

Cited by 8 publications

(10 citation statements)

References 36 publications

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“…5 Delaying surgery allows more time for spontaneous neurological recovery, which may still occur one year after injury, although this is more likely in individuals with motor incomplete injuries and likelihood of achieving functional strength in clinically relevant upper limb muscles has been reported to be very low (3% of individuals regained > 3 finger flexion strength between 6-12 months after injury, if initial strength grade was 0-2). 23,24 In the present study, infralesional LMN abnormality was observed in the majority of limbs tested, especially in the functionally critical C8-T1 myotomes, which are responsible for grasp function. This means that individuals who opt to wait for spontaneous recovery may lose their candidacy or have a sub-optimal response to nerve transfer surgery.…”

Section: Discussionsupporting

confidence: 53%

Segmental infralesional lower motor neuron abnormalities in patients with sub-acute traumatic spinal cord injury

Berger

Adewuyi

Doherty

et al. 2023

Preprint

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The health of the infralesional lower motor neuron (LMN) has received little attention in individuals with traumatic cervical spinal cord injuries (SCI). Infralesional LMN health is clinically relevant in the context of nerve transfer surgery to restore critical upper limb functions, as those demonstrating LMN damage below the neurological level of injury may experience irreversible sequelae of denervation (e.g., atrophy, fibrosis) without timely intervention. In this two-centre retrospective cohort study, we examined the health of the infralesional LMN in individuals with traumatic cervical SCI, using data derived from the clinical electrodiagnostic examination performed early after SCI. We assessed 66 limbs in 42 individuals with traumatic cervical SCI (40 males, mean age = 43.6+/-17.2, mean duration from injury = 3.3+/-1.5 months, 25 with motor complete injuries). Analysis was stratified by injury level as 1) C4 and above, 2) C5 and 3) C6-7. EMG performed on representative muscles from C5-6, C6-7, C7-8 and C8-T1, were included in analysis. LMN abnormality was dichotomized as present (abnormal spontaneous activity) or absent. Data were pooled for the most caudal infralesional segment (C8-T1). Overall, a high frequency of denervation potentials was seen in all infralesional segments for all injury levels. The pooled frequency of denervation potentials at C8-T1 was 74.6% of limbs tested. There was also evidence of denervation potentials at the rostral border of the neurological level of injury, as high as 64.3% of C5-6 muscles for C5 injuries. These data support a high prevalence of infralesional LMN abnormality following SCI, which has implications to candidacy, timing of the intervention, donor nerve options and motor prognosis following SCI.

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Section: Discussionsupporting

confidence: 53%

Segmental infralesional lower motor neuron abnormalities in patients with sub-acute traumatic spinal cord injury

Berger

Adewuyi

Doherty

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…5 Delaying surgery allows more time for spontaneous neurological recovery, which may still occur one year after injury, although this is more likely in individuals with motor incomplete injuries and likelihood of achieving functional strength in clinically relevant upper limb muscles has been reported to be very low (3% of individuals regained > 3 nger exion strength between 6-12 months after injury, if initial strength grade was 0-2) . 23,24 In the present study, infralesional LMN abnormality was observed in the majority of limbs tested, especially in the functionally critical C8-T1 myotomes, which are responsible for grasp function. This means that individuals who opt to wait for spontaneous recovery may lose their candidacy or have a sub-optimal response to nerve transfer surgery.…”

Section: Discussionsupporting

confidence: 49%

Segmental infralesional denervation potentials in sub-acute traumatic spinal cord injury

Berger¹,

Adewuyi²,

Doherty³

et al. 2023

Preprint

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Study Design: Two-centre retrospective cohort study. Objectives: We examined the health of the infralesional LMN in individuals with traumatic cervical SCI, using data derived from the clinical electrodiagnostic examination performed early after SCI. Setting: Academic hospitals. Methods: We assessed 66 limbs in 42 individuals (40 males, mean age = 43.6±17.2, mean duration from injury = 3.3±1.5 months, 25 with motor complete injuries). Analysis was stratified by injury level as 1) C4 and above, 2) C5 and 3) C6-7. EMG performed on representative muscles from C5-6, C6-7, C7-8 and C8-T1, were included in analysis. LMN abnormality was dichotomized as present (abnormal spontaneous activity) or absent. Data were pooled for the most caudal infralesional segment (C8-T1). Results: A high frequency of denervation potentials was seen in all infralesional segments for all injury levels. The pooled frequency of denervation potentials at C8-T1 was 74.6% of limbs tested. There was also evidence of denervation potentials at the rostral border of the neurological level of injury, as high as 64.3% of C5-6 muscles for C5 injuries. Conclusion: These data support a high prevalence of infralesional LMN abnormality following SCI, which has implications to candidacy, timing of the intervention and donor nerve options.

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“…Over half of these are at the cervical level and profoundly affect the individual's upper extremity (UE) movement and function [3] . Restoring UE function is essential to performing basic activities of daily living (ADLs) and can improve independence in this setting [4,5] .…”

Section: Introductionmentioning

confidence: 99%

Review of outcomes measures used to evaluate upper extremity surgical treatment of cervical spinal cord injury with recommendations for the future

Lin,

Fox

2024

Plast Aesthet Res

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Cervical spinal cord injury is a life-altering event that profoundly affects an individual’s upper extremity function. Nerve transfer surgeries have been shown to restore more natural movement and fine motor control in this population. At present, there is no consensus on how to evaluate the efficacy of these restorative surgeries. The purpose of this work was to perform a comprehensive review of the existing literature and describe the outcome measures used. We hypothesized that the assessments will be heterogeneous across studies and will incompletely capture the effect of nerve transfers on upper extremity motion in cervical spinal cord injury. A search strategy was designed and a review of multiple databases (Embase.com, Ovid-Medline All, and Scopus) yielded 481 articles; 26 unique studies met inclusion criteria and underwent analysis. Both manual muscle strength testing and video content were presented in the majority of studies. Outcome assessments including myometry, functional outcomes measures (such as the grasp and release test), patient-reported outcomes (including generic, extremity, and disease-specific types), and custom de novo questionnaires were used variably across studies. Future work should focus on standardizing outcomes measures in the field and developing and incorporating kinematic analysis to quantify the intricate, coordinated, and precise movement attained after nerve transfer surgery in the setting of cervical spinal cord injury.

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Spontaneous Motor Recovery after Cervical Spinal Cord Injury: Issues for Nerve Transfer Surgery Decision Making

Cited by 8 publications

References 36 publications

Segmental infralesional lower motor neuron abnormalities in patients with sub-acute traumatic spinal cord injury

Segmental infralesional lower motor neuron abnormalities in patients with sub-acute traumatic spinal cord injury

Segmental infralesional denervation potentials in sub-acute traumatic spinal cord injury

Review of outcomes measures used to evaluate upper extremity surgical treatment of cervical spinal cord injury with recommendations for the future

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