Download PDF
J Brachial Plex Peripher Nerve Inj 2015; 10(01): e34-e42
DOI: 10.1055/s-0035-1558427
Review Article
Georg Thieme Verlag KG Stuttgart · New York

Review of Upper Extremity Nerve Transfer in Cervical Spinal Cord Injury

Sarah A. Cain
1   Department of Plastic and Reconstructive Surgery, The Royal Melbourne Hospital, Parkville, Victoria, Australia
,
Andreas Gohritz
2   Tetraplegia Hand Surgery, Swiss Paraplegia Centre, Nottwil, Switzerland
3   Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, University Hospital, Basel, Switzerland
,
Jan Fridén
2   Tetraplegia Hand Surgery, Swiss Paraplegia Centre, Nottwil, Switzerland
4   Center of Advanced Reconstruction of Extremities (CARE), National Reference Center for Tetraplegia Surgery, Sahlgrenska University Hospital, Göteborg, Sweden
,
Natasha van Zyl
1   Department of Plastic and Reconstructive Surgery, The Royal Melbourne Hospital, Parkville, Victoria, Australia
5   Victorian Spinal Cord Service, Austin Health, Heidelberg, Victoria, Australia
6   Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
› Author Affiliations
Further Information

Publication History

09 March 2015

03 June 2015

Publication Date:
06 August 2015 (online)

Also available at
   Permissions and Reprints

Abstract

Objective Several nerve transfers have now been successfully performed for upper limb reanimation in tetraplegia. This study was performed to review the use of nerve transfers for upper limb reanimation in tetraplegia.

Methods Medline and Embase (1950 to February 11, 2015) were searched using a search strategy designed to include any studies that reported cases of nerve transfer in persons with cervical spinal cord injury (SCI).

Results A total of 103 manuscripts were selected initially and full-text analysis produced 13 studies with extractable data. Of these manuscripts, 10 reported single cases and 3 reported case series. Eighty-nine nerve transfers have been performed in 57 males and 2 females with a mean age of 34 years. The mean SCI level was C6 (range: C5–7), time to surgery post-SCI was 19.9 months (range: 4.1–156 months), and follow-up time was 18.2 months (range: 3–60 months). All case reports recorded a Medical Research Council (MRC) score of 3 or 4 for recipient muscle power, but two early case series reported more variable results.

Conclusion This review documents the current status of nerve transfer surgery for upper limb reanimation in tetraplegia and summarizes the functional results in 59 cases with 89 nerve transfers performed, including 15 cases of double-nerve transfer and 1 case of triple-nerve transfer.

Keywords

nerve transfer - tetraplegia - spinal cord injury - quadriplegia

Note

Portions of this work were presented in abstract/oral presentation form in proceedings at the Australian Hand Surgery Society Annual Scientific Meeting, Gold Coast, Queensland, 2014.


 

  • References

  • 1 Bickenbach J. International Perspectives on Spinal Cord Injury. World Health Organization; 2013
    Search in Google Scholar
  • 2 Anderson KD. Targeting recovery: priorities of the spinal cord-injured population. J Neurotrauma 2004; 21 (10) 1371-1383
    CrossrefPubMedSearch in Google Scholar
  • 3 Hentz VR, Leclercq C. Surgical Rehabilitation of the Upper Limb in Tetraplegia. New York, NY: WB Saunders; 2002
    Search in Google Scholar
  • 4 Yang LJ, Chang KW, Chung KC. A systematic review of nerve transfer and nerve repair for the treatment of adult upper brachial plexus injury. Neurosurgery 2012; 71 (2) 417-429 , discussion 429
    CrossrefPubMedSearch in Google Scholar
  • 5 Addas BM, Midha R. Nerve transfers for severe nerve injury. Neurosurg Clin N Am 2009; 20 (1) 27-38 , vi
    CrossrefPubMedSearch in Google Scholar
  • 6 Brown JM, Mackinnon SE. Nerve transfers in the forearm and hand. Hand Clin 2008; 24 (4) 319-340 , v
    CrossrefPubMedSearch in Google Scholar
  • 7 Benassy J. A case of transposition of the musculo-cutaneous nerve upon the median nerve. Paraplegia 1965; 3 (3) 199-202
    PubMedSearch in Google Scholar
  • 8 Kiwerski J. Recovery of simple hand function in tetraplegia patients following transfer of the musculo-cutaneous nerve into the median nerve. Paraplegia 1982; 20 (4) 242-247
    CrossrefPubMedSearch in Google Scholar
  • 9 Krasuski M, Kiwerski J. An analysis of the results of transferring the musculocutaneous nerve onto the median nerve in tetraplegics. Arch Orthop Trauma Surg 1991; 111 (1) 32-33
    CrossrefPubMedSearch in Google Scholar
  • 10 Bertelli JA, Ghizoni MF. Nerve transfers for elbow and finger extension reconstruction in midcervical spinal cord injuries. J Neurosurg 2015; 122 (1) 121-127
    CrossrefPubMedSearch in Google Scholar
  • 11 Bertelli JA, Ghizoni MF. Single-stage surgery combining nerve and tendon transfers for bilateral upper limb reconstruction in a tetraplegic patient: case report. J Hand Surg Am 2013; 38 (7) 1366-1369
    CrossrefPubMedSearch in Google Scholar
  • 12 Brown JM. Nerve transfers in tetraplegia I: background and technique. Surg Neurol Int 2011; 2: 121
    CrossrefPubMedSearch in Google Scholar
  • 13 van Zyl N, Hahn JB, Cooper CA, Weymouth MD, Flood SJ, Galea MP. Upper limb reinnervation in C6 tetraplegia using a triple nerve transfer: case report. J Hand Surg Am 2014; 39 (9) 1779-1783
    CrossrefPubMedSearch in Google Scholar
  • 14 Bertelli JA, Ghizoni MF. Transfer of nerve branch to the brachialis to reconstruct elbow extension in incomplete tetraplegia: case report. J Hand Surg Am 2012; 37 (10) 1990-1993
    CrossrefPubMedSearch in Google Scholar
  • 15 Bertelli JA, Ghizoni MF, Tacca CP. Transfer of the teres minor motor branch for triceps reinnervation in tetraplegia. J Neurosurg 2011; 114 (5) 1457-1460
    PubMedSearch in Google Scholar
  • 16 Bertelli JA, Mendes Lehm VL, Tacca CP, Winkelmann Duarte EC, Ghizoni MF, Duarte H. Transfer of the distal terminal motor branch of the extensor carpi radialis brevis to the nerve of the flexor pollicis longus: an anatomic study and clinical application in a tetraplegic patient. Neurosurgery 2012; 70 (4) 1011-1016 , discussion 1016
    CrossrefPubMedSearch in Google Scholar
  • 17 Bertelli JA, Tacca CP, Ghizoni MF, Kechele PR, Santos MA. Transfer of supinator motor branches to the posterior interosseous nerve to reconstruct thumb and finger extension in tetraplegia: case report. J Hand Surg Am 2010; 35 (10) 1647-1651
    CrossrefPubMedSearch in Google Scholar
  • 18 Bertelli JA, Tacca CP, Winkelmann Duarte EC, Ghizoni MF, Duarte H. Transfer of axillary nerve branches to reconstruct elbow extension in tetraplegics: a laboratory investigation of surgical feasibility. Microsurgery 2011; 31 (5) 376-381
    CrossrefPubMedSearch in Google Scholar
  • 19 Mackinnon SE, Yee A, Ray WZ. Nerve transfers for the restoration of hand function after spinal cord injury. J Neurosurg 2012; 117 (1) 176-185
    CrossrefPubMedSearch in Google Scholar
  • 20 Fridén J, Gohritz A. Brachialis-to-extensor carpi radialis longus selective nerve transfer to restore wrist extension in tetraplegia: case report. J Hand Surg Am 2012; 37 (8) 1606-1608
    CrossrefPubMedSearch in Google Scholar
  • 21 Kakulas BA. Neuropathology: the foundation for new treatments in spinal cord injury. Spinal Cord 2004; 42 (10) 549-563
    CrossrefPubMedSearch in Google Scholar
  • 22 Senjaya F, Midha R. Nerve transfer strategies for spinal cord injury. World Neurosurg 2013; 80 (6) 319-326
    CrossrefPubMedSearch in Google Scholar
  • 23 Bryden AM, Peljovich AE, Hoyen HA, Nemunaitis G, Kilgore KL, Keith MW. Surgical restoration of arm and hand function in people with tetraplegia. Top Spinal Cord Inj Rehabil 2012; 18 (1) 43-49
    CrossrefPubMedSearch in Google Scholar
  • 24 Connolly SJ, Aubut JL, Teasell R, Jarus T. Enhancing upper extremity function with reconstructive surgery in persons with tetraplegia: a review of the literature. Top Spinal Cord Inj Rehabil 2007; 13 (1) 58-80
    PubMedSearch in Google Scholar
  • 25 Reinholdt C, Fridén J. Outcomes of single-stage grip-release reconstruction in tetraplegia. J Hand Surg Am 2013; 38 (6) 1137-1144
    CrossrefPubMedSearch in Google Scholar
  • 26 MR C. Aids to the Examination of the Peripheral Nervous System. Medical Research Council War Memorandum. London HMSO 45; 1976
    PubMedSearch in Google Scholar
  • 27 Law M, Baptiste S, McColl M, Opzoomer A, Polatajko H, Pollock N. The Canadian occupational performance measure: an outcome measure for occupational therapy. Can J Occup Ther 1990; 57 (2) 82-87
    CrossrefPubMedSearch in Google Scholar
  • 28 Lyle RC. A performance test for assessment of upper limb function in physical rehabilitation treatment and research. Int J Rehabil Res 1981; 4 (4) 483-492
    CrossrefPubMedSearch in Google Scholar
  • 29 Catz A, Itzkovich M, Agranov E, Ring H, Tamir A. SCIM—spinal cord independence measure: a new disability scale for patients with spinal cord lesions. Spinal Cord 1997; 35 (12) 850-856
    CrossrefPubMedSearch in Google Scholar
  • 30 Mackinnon SE, Ray WZ. Response. J Neurosurg 2013; 118 (3) 707-708
    PubMedSearch in Google Scholar
  • 31 Anderson KD, Fridén J, Lieber RL. Acceptable benefits and risks associated with surgically improving arm function in individuals living with cervical spinal cord injury. Spinal Cord 2009; 47 (4) 334-338
    CrossrefPubMedSearch in Google Scholar
  • 32 McDowell CL, Moberg EA, House JH. The Second International Conference on Surgical Rehabilitation of the Upper Limb in Tetraplegia. J Hand Surg Am 1986; 11: 604-608
    CrossrefPubMedSearch in Google Scholar