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01-03-2015

Use of peripheral nerve transfers in tetraplegia: evaluation of feasibility and morbidity

Authors: Ida K. Fox, Kristen M. Davidge, Christine B. Novak, Gwendolyn Hoben, Lorna C. Kahn, Neringa Juknis, Rimma Ruvinskaya, Susan E. Mackinnon

Published in: HAND | Issue 1/2015

Abstract

Background

Peripheral nerve transfers are being used to improve upper extremity function in cervical spinal cord injury (SCI) patients. The purpose of this study was to evaluate feasibility and perioperative complications following these procedures.

Methods

Eligible SCI patients with upper extremity dysfunction were assessed and followed for a minimum of 3 months after surgery. Data regarding demographics, medical history, physical examination, electrodiagnostic testing, intraoperative nerve stimulation, recipient nerve histomorphometry, surgical procedure, and complications were collected.

Results

Seven patients had surgery on eight limbs, mean age of 28 ± 9.9 years and mean time from SCI injury of 5.1 ± 5.2 years. All patients had volitional elbow flexion and no volitional hand function. The nerve to the brachialis muscle was used as the expendable donor, and the recipients included the anterior interosseous nerve (AIN) (for volitional prehension), nerve branches to the flexor carpi radialis, and flexor digitorum superficialis. Two patients underwent additional nerve transfers: (1) supinator to extensor carpi ulnaris or (2) deltoid to triceps. No patients had any loss of baseline upper extremity function, seven of eight AIN nerve specimens had preserved micro-architecture, and all intraoperative stimulation of recipient neuromuscular units was successful further supporting feasibility. Four patients had perioperative complications; all resolved or improved (paresthesias).

Conclusion

Nerve transfers can be used to reestablish volitional control of hand function in SCI. This surgery does not downgrade existing function, uses expendable donor nerve, and has no postoperative immobilization, which might make it a more viable option than traditional tendon transfer and other procedures.

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Title: Use of peripheral nerve transfers in tetraplegia: evaluation of feasibility and morbidity
Authors: Ida K. Fox
Kristen M. Davidge
Christine B. Novak
Gwendolyn Hoben
Lorna C. Kahn
Neringa Juknis
Rimma Ruvinskaya
Susan E. Mackinnon
Publication date: 01-03-2015
Publisher: Springer US
Published in: HAND / Issue 1/2015
Print ISSN: 1558-9447
Electronic ISSN: 1558-9455
DOI: https://doi.org/10.1007/s11552-014-9677-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Use of peripheral nerve transfers in tetraplegia: evaluation of feasibility and morbidity

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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