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Double nerve transfer for restoration of hand grasp and release in C7 tetraplegia following complete cervical spinal cord injury

  • Case Report - Peripheral Nerves
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Abstract

Cervical spinal cord injury (SCI) can cause tetraplegia. Nerve transfer has been routinely utilized for reconstruction of hand in brachial plexus injuries. Here, we report reconstruction of finger flexion (hand grasp) and extension (hand release) in a victim of cervical spinal cord injury with tetraplegia. We also focus on importance of extension phase in restoration of hand function in the tetraplegic case, in addition to provision of a detailed description of both operations including text, photographs, and a video. We used double nerve transfer, namely brachialis branches of musculocutaneous nerve to anterior interosseous nerve (AIN) and supinator branch of radial nerve to posterior interosseous nerve (PIN). We found that brachialis nerve transfer to AIN (for finger flexion) and supinator branch nerve transfer to PIN (for finger extension) can provide finger flexion and extension simultaneously. Brachialis nerve transfer to AIN and supinator branch nerve transfer to PIN may be an acceptable surgical technique to restore hand grasp and release in tetraplegia after SCI.

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Authors and Affiliations

  1. Brachial Plexus and Peripheral Nerve Injury Center, Guilan University of Medical Sciences, Rasht, Iran

    Mohammadreza Emamhadi

  2. Neuroscience Research Center, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran

    Sasan Andalib

  3. Department of Neurosurgery, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran

    Sasan Andalib

Authors
  1. Mohammadreza Emamhadi
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  2. Sasan Andalib
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Corresponding author

Correspondence to Mohammadreza Emamhadi.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Guilan University of Medical Sciences) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained.

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Comments

A well planned, executed, documented, and described clinical case report addressing a challenging spinal cord injury problem with very good restoration of important and useful hand function.

Michel Kliot

California, USA

Doctors Emamhadi and Andalib report on a C7 quadriplegic patient who benefited significantly from nerve transfers. As outlined in their discussion section, there has been sparse literature on using nerve transfers to improve the life of quadriplegic patients. The results published thus far are very encouraging. Figures 5 and 6 demonstrate the benefit the patient received from the procedure. Other nerve transfers that have been reported in quadriplegic patients are a transfer of the AIN to the ECRL for improvement of wrist extension and stabilization of the hand. To improve wrist extension transfer of the teres or deltoid branches on the axillary nerve to triceps branches of the radial nerve to restore elbow extension. If this latter transfer proved to be successful, quadriplegic patients that were wheel chair bound could use their triceps to help transfer from their wheel chairs to the bed. I congratulate the authors on their excellent results. I will be following this literature to try to determine the optimal time for transfers and also to judge the efficacy of these transfers. The alternate strategy for improving hand grip in quadriplegic patients is spinal cord stimulation. Both of these techniques open new doors for improving the lives of this unfortunate group of patients.

Allan Friedman

North Carolina, USA

This article is part of the Topical Collection on Peripheral Nerves

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Emamhadi, M., Andalib, S. Double nerve transfer for restoration of hand grasp and release in C7 tetraplegia following complete cervical spinal cord injury. Acta Neurochir 160, 2219–2224 (2018). https://doi.org/10.1007/s00701-018-3671-0

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  • DOI: https://doi.org/10.1007/s00701-018-3671-0

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