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

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HAND

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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Acknowledgments

Additional work was done by the following individuals, and without their input, this research would have been impossible. Mr. AY provided preoperative and intraoperative videography and photography and created the schematic figures. Mr. DH performed the nerve specimen histomorphometry. Dr. CZ performed and interpreted the electrodiagnostic testing and was instrumental in developing the protocol for the preoperative workup of these patients.

Conflict of interest

IF and LK have received travel/accommodation reimbursement from the Paralyzed Veterans of America organization for attendance and lecture at the 2013 Annual PVA Expo and Summit. SM has received NIH funding for unrelated research.

Funding

This study has not received grant funding.

Statement of informed consent

Additional informed consent was obtained from all patients for which identifying information is included in this article in the form of a formal and signed media consent.

Statement of human and animal rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5). Informed consent was obtained from all patients for being included in the study. This article does not contain any studies with animal subjects.

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Authors and Affiliations

  1. Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, Box 8238, 660 South Euclid Avenue, Saint Louis, MO, 63110, USA

    Ida K. Fox, Gwendolyn Hoben & Susan E. Mackinnon

  2. Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada

    Kristen M. Davidge

  3. Hand and Upper Extremity Program, Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto Western Hospital, 399 Bathurst Street, EW2-422, Toronto, ON, M5T 2S8, Canada

    Christine B. Novak

  4. Milliken Hand Center, The Rehabilitation Institute of Saint Louis, Suite 6F, 4921 Parkview Place, Saint Louis, MO, 63110, USA

    Lorna C. Kahn

  5. Division of Neurorehabilitation, Spinal Cord Injury Program, Department of Neurology, Washington University School of Medicine, Box 8518, 660 South Euclid Avenue, Saint Louis, MO, 63110, USA

    Neringa Juknis & Rimma Ruvinskaya

Authors
  1. Ida K. Fox
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  2. Kristen M. Davidge
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  3. Christine B. Novak
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  4. Gwendolyn Hoben
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  5. Lorna C. Kahn
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  7. Rimma Ruvinskaya
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  8. Susan E. Mackinnon
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Corresponding author

Correspondence to Ida K. Fox.

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Fox, I.K., Davidge, K.M., Novak, C.B. et al. Use of peripheral nerve transfers in tetraplegia: evaluation of feasibility and morbidity. HAND 10, 60–67 (2015). https://doi.org/10.1007/s11552-014-9677-z

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  • DOI: https://doi.org/10.1007/s11552-014-9677-z

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