Treatment of Central Paralysis of Upper Extremity Using Contralateral C7 Nerve Transfer via Posterior Spinal Route

Guan, Jingyu; Lin, Jin; Guan, Xueqing; Jin, Qiang

doi:10.1016/j.wneu.2019.01.181

Cited by 15 publications

(13 citation statements)

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“…CC7 transfer was first described in 1992 [1] and was later described using the anterior vertebral approach for the treatment of central upper limb spastic paralysis. [ 2 – 4 ] CC7 transfer using the posterior approach was described in 2019 [5] and avoids the complications of the anterior approach. SPR of the cervical nerve alone can be used to improve spasticity without neuromotor regeneration, [ 6 , 9 – 11 ] but it was not tried before in combination with CC7 transfer using the posterior approach.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, it avoids nerve transplantation, reduces the possible complications of vertebral artery injury, esophageal fistula, and upper limb pain during swallowing caused by the anterior vertebral approach. [5] Selective posterior rhizotomy (SPR) of the cervical nerve alone can comprehensively improve spasticity but without neuromotor regeneration. [6]…”

Section: Introductionmentioning

confidence: 99%

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Contralateral C7 nerve transfer through posterior vertebral approach combined with selective posterior rhizotomy of the affected cervical nerve in the treatment of central upper limb spastic paralysis

Guan

Lin

Guan³

et al. 2021

Medicine

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Introduction: C7 nerve transfer alone can improve upper limb motor function and partial spasticity. Selective posterior rhizotomy (SPR) of the cervical nerve alone can comprehensively improve spasticity but without neuromotor regeneration. We propose a novel possible improvement of contralateral C7 (CC7) nerve transfer through the posterior vertebral approach, which was combined with SPR of the affected cervical nerve. Patient Concerns: A 33-year-old male patient presented with cerebral hemorrhage of the left basal ganglia, paralysis of the right limbs, and hypesthesia 8 months earlier. The dysfunction of the affected hand was already present at admission. The patient reported a previous history of hypertension for several years and oral antihypertensive drugs, and blood pressure was controlled within a normal range. Diagnosis: Central upper limb spastic paralysis. The muscle strength of the right lower limb was grade IV. The Fugl-Meyer score of the right upper limb was 7 points, and the modified Ashworth score was 10. Interventions: The patient underwent CC7 transfer and SPR. Outcomes: The patient successfully underwent CC7 transfer and SPR without complications. On the day after surgery, the left upper limb motions were normal. The Fugl-Meyer score was 9, and the modified Ashworth score of the right upper limb was 2. Conclusions: CC7 nerve transfer through the posterior vertebral approach combined with SPR of the affected cervical nerve can possibly improve the surgical outcomes of selected patients with upper limb motor dysfunction and partial spasticity. This method has not been reported in the literature before, and additional studies are necessary.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Contralateral C7 nerve transfer through posterior vertebral approach combined with selective posterior rhizotomy of the affected cervical nerve in the treatment of central upper limb spastic paralysis

Guan

Lin

Guan³

et al. 2021

Medicine

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“…Previous studies have reported the hemiplegia cases which required nerve grafting for C7 ‐ C7 transfer via prespinal route (Li et al., 2015; Wang, Hu, & Wang, 2003). Academician GuYudong (Guan, Lin, Guan, & Qiang, 2019) discovered for the first time that the contralateral cervical 7 nerve could provide a powerful source of the dynamic nerve without obvious damage to the contralateral function and first innovated the contralateral cervical 7 nerve transposition through anterior cervical subcutaneous approach, which has become a classic surgical procedure of contralateral nerve root transposition. However, in this approach, the nerve needs to be bridged long.…”

Section: Discussionmentioning

confidence: 99%

Preliminary results of posterior contralateral cervical 7 nerve transposition in the treatment of upper limb plegia after a stroke

et al. 2020

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“…To date, these studies have not yet been replicated in the Western world, but several case reports from China have reported similar findings at single case level [ 26 , 27 ] and described alternative routes for the development of safe short tunnels for transfer, including a posterior spinal approach by Guan et al using a posterior approach involving a C7 laminectomy [ 26 ].…”

Section: Contralateral C7 Nerve Transfer In Human Strokementioning

confidence: 99%

Contralateral C7 Nerve Transfer for Stroke Recovery: New Frontier for Peripheral Nerve Surgery

Alawieh

Yong

Boulis

2021

JCM

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Ischemic stroke remains a major cause of disability in the United States and worldwide. Following the large-scale implementation of stroke thrombectomy and the optimization of treatment protocols for acute stroke, the reduction in stroke-associated mortality has resulted in an increased proportion of stroke survivors, many of whom have moderate to severe disability. To date, the treatment of subacute and chronic stroke has remained a challenge. Several approaches, involving pharmacological interventions to promote neuroplasticity, brain stimulation strategies and rehabilitative interventions, are currently being explored at different stages of the translational spectrum, yet level 1 evidence is still limited. In a recent landmark study, surgical intervention using contralateral C7 nerve transfer, an approach used to treat brachial plexus injury, was implemented in patients with chronic stroke, demonstrating an added benefit to standard rehabilitation strategies, leading to improved motor performance and reduced spasticity. The procedure involved the transfer of the C7 nerve root and middle trunk from the uninjured extremity to the injured extremity using a short conduit that allows for faster regeneration and innervation of the injured upper extremity via the ipsilateral (contralesional) hemisphere. In this work, we review the rationale for using contralateral C7 nerve transfer in stroke, describe the surgical intervention with associated variations and limitations, and discuss the current evidence for the efficacy of this technique in ischemic stroke research.

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Treatment of Central Paralysis of Upper Extremity Using Contralateral C7 Nerve Transfer via Posterior Spinal Route

Cited by 15 publications

References 13 publications

Contralateral C7 nerve transfer through posterior vertebral approach combined with selective posterior rhizotomy of the affected cervical nerve in the treatment of central upper limb spastic paralysis

Contralateral C7 nerve transfer through posterior vertebral approach combined with selective posterior rhizotomy of the affected cervical nerve in the treatment of central upper limb spastic paralysis

Preliminary results of posterior contralateral cervical 7 nerve transposition in the treatment of upper limb plegia after a stroke

Contralateral C7 Nerve Transfer for Stroke Recovery: New Frontier for Peripheral Nerve Surgery

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