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Contralateral cervical seventh nerve transfer for spastic arm paralysis via a modified prespinal route: a cadaveric study

  • Original Article - Neurosurgical Anatomy
  • Published:
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Abstract

Background

We proposed contralateral cervical seventh nerve transfer for spastic arm paralysis after central neurological injury in the New England Journal of Medicine (NEJM) in 2018. In this surgery, we applied a new surgical route for nerve transfer, the Huashan prespinal route. The objective of this study was to elaborate our new surgical technique, clarify its relationship to the vertebral artery, and provide anatomical data on this novel method.

Methods

The effectiveness and safety of the Huashan prespinal route in contralateral C7 nerve transfer were evaluated anatomically. Nine cadavers (4 males, 5 females) were available for this study. Among these, anatomical parameters of the vertebral artery were obtained from 6 cadavers, and the anastomosis of the bilateral cervical seventh nerve was observed on 3 cadavers undergoing contralateral C7 nerve transfer via the Huashan prespinal route.

Results

Tension-free anastomosis of the bilateral cervical seventh nerve was achieved through the Huashan prespinal route. The tilt angle of the vertebral artery to the sagittal plane (with thyroid cartilage as the origin) was 25.5 ± 4.5°, at 22.5 ± 1.6° and 28.7 ± 4.3° on the left and right side, respectively. The safe drilling angle to penetrate through the longus colli muscles for the creation of a longus colli muscle tunnel to avoid injury to the vertebral artery in our surgical technique was above 33.2°.

Conclusions

The cadaveric study confirms that the presented technique allowed simple, effective, and safe contralateral C7 nerve transfer. This technique can be used in the treatment of hemiplegia and brachial plexus injury. There is a safe scope of drilling angle for creating the longus colli muscle tunnel required for this surgical route. The anatomical parameters obtained in this study will be helpful for the performance of this operation.

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Abbreviations

C7:

Cervical seventh nerve

SCN:

Sternocleidomastoid muscle

References

  1. Dobkin BH (2005) Clinical practice. Rehabilitation after stroke. N Engl J Med 352:1677–1684

    CAS  PubMed  PubMed Central  Google Scholar 

  2. Feng J, Wang T, Gu Y, Chen L, Zhang G, Zhu Y (2010) Contralateral C7 transfer to lower trunk via a subcutaneous tunnel across the anterior surface of chest and neck for total root avulsion of the brachial plexus: a preliminary report. Neurosurgery 66(6 Suppl Operative):252–263

    PubMed  Google Scholar 

  3. Fugl-Meyer AR, Jääskö L, Leyman I, Olsson S, Steglind S (1975) The post-stroke hemiplegic patient. 1. A method for evaluation of physical performance. Scand J Rehabil Med 7:13–31

    CAS  PubMed  Google Scholar 

  4. Gu YD, Zhang GM, Chen DS, Yan JG, Cheng XM, Chen L (1992) Seventh cervical nerve root transfer from the contralateral healthy side for treatment of brachial plexus root avulsion. J Hand Surg (Edinb) 17:518–521

    Article  CAS  Google Scholar 

  5. Gu Y, Xu J, Chen L, Wang H, Hu S (2002) Long term outcome of contralateral C7 transfer: a report of 32 cases. Chin Med J 115:866–868

    PubMed  Google Scholar 

  6. Hua XY, Qiu YQ, Li T, Zheng MX, Shen YD, Jiang S, Xu JG, Gu YD, Xu WD (2015) Contralateral peripheral neurotization for hemiplegic upper extremity after central neurologic injury. Neurosurgery 76:187–195

    Article  PubMed  Google Scholar 

  7. Huang W-M, Gao Z, Ran C-F et al (2003) Evaluation of early movement intervention for functional recover of patients with stroke. Chin J Clin Rehabil 7:3484–3485

    Google Scholar 

  8. Jiang S, Li ZY, Hua XY, Xu WD, Xu JG, Gu YD (2010) Reorganization in motor cortex after brachial plexus avulsion injury and repair with the contralateral C7 root transfer in rats. Microsurgery 30:314–320

    PubMed  Google Scholar 

  9. Makki D, Duodu J, Nixon M (2014) Prevalence and pattern of upper limb involvement in cerebral palsy. J Child Orthop 8:215–219

    Article  PubMed  PubMed Central  Google Scholar 

  10. McGuiness CN, Kay SP (2002) The prespinal route in contralateral C7 nerve root transfer for brachial plexus avulsion injuries. J Hand Surg (Edinb) 27:159–160

    Article  CAS  Google Scholar 

  11. Sauser K, Burke JF, Reeves MJ, Barsan WG, Levine DA (2014) A systematic review and critical appraisal of quality measures for the emergency care of acute ischemic stroke. Ann Emerg Med 64:235–244.e235

    Article  PubMed  Google Scholar 

  12. Spinner RJ, Shin AY, Bishop AT (2018) Rewiring to regain function in patients with spastic hemiplegia. N Engl J Med. 378(1):83–84. https://doi.org/10.1056/NEJMe1713313

    Article  PubMed  Google Scholar 

  13. Wang S, Yiu HW, Li P, Li Y, Wang H, Pan Y (2012) Contralateral C7 nerve root transfer to neurotize the upper trunk via a modified prespinal route in repair of brachial plexus avulsion injury. Microsurgery 32:183–188

    Article  CAS  PubMed  Google Scholar 

  14. Xu L, Gu Y, Xu J, Lin S, Chen L, Lu J (2008) Contralateral C7 transfer via the prespinal and retropharyngeal route to repair brachial plexus root avulsion: a preliminary report. Neurosurgery 63:553–558 discussion 558-559

    Article  PubMed  Google Scholar 

  15. Xu WD, Hua XY, Zheng MX, Xu JG, Gu YD (2011) Contralateral C7 nerve root transfer in treatment of cerebral palsy in a child: case report. Microsurgery 31:404–408

    Article  PubMed  Google Scholar 

  16. Zheng MX, Hua XY, Feng JT, Li T, Lu YC, Shen YD, Cao XH, Zhao NQ, Lyu JY, Xu JG, Gu YD, Xu WD (2018) Trial of contralateral seventh cervical nerve transfer for spastic arm paralysis. N Engl J Med 378:22–34

    Article  PubMed  Google Scholar 

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Funding

This study was supported by grants from the National Key R&D Program of China (2017YFC0840100 and 2017YFC0840106), Distinguished Young Scientists (81525009), Key Program of National Science Foundation of China (81830063), Priority among Priorities of Shanghai Municipal Clinical Medicine Center (2017ZZ01006), Technology Innovation Program of Shanghai Science, and Technology Committee (18411950100).

Author information

Author notes

  1. PeiYang Li, Yundong Shen and Jing Xu contributed equally to this work.

Authors and Affiliations

  1. Department of Hand Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, 12 Wulumuqi Middle Road, Shanghai, 200040, China

    PeiYang Li, Yundong Shen, Jing Xu, Su Jiang, Huawei Yin, Juntao Feng, Tie Li, Jun Shen, Guobao Wang, Baofu Yu, Xuan Ye, Aiping Yu, Gaowei Lei, Zeyu Cai & Wendong Xu

  2. Department of Anatomy, Histology & Embryology, Shanghai Medical College, Fudan University, Shanghai, China

    Chunmin Liang

  3. Department of Hand and Upper Extremity Surgery, Jing’an District Central Hospital, Shanghai, China

    Yanqun Qiu & Wendong Xu

  4. State Key Laboratory of Medical Neurobiology, Collaborative Innovation Center of Brain Science, Fudan University, Shanghai, China

    Wendong Xu

  5. Priority Among Priorities of Shanghai Municipal Clinical Medicine Center, Shanghai, China

    Wendong Xu

  6. National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China

    Wendong Xu

Authors
  1. PeiYang Li
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  2. Yundong Shen
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  4. Chunmin Liang
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  5. Su Jiang
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  10. Jun Shen
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  12. Baofu Yu
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  13. Xuan Ye
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  16. Zeyu Cai
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  17. Wendong Xu
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Corresponding author

Correspondence to Wendong Xu.

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Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

For this type of study, formal consent is not required.

Informed consent

This article does not contain any studies with human participants performed by any of the authors.

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Comments

The authors describe an interesting anatomical approach of bilateral C7 transfer for a novel but tested clinical application - the treatment of upper extremity spasticity due to a central neurological injury. As mentioned, the results of this approach were described in a 2018 NEJM article. Before general adoption of this technique, the mechanism(s) mediating the effects need to be better understood [12]

Michel Kliot

CA, USA

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This article is part of the Topical Collection on Neurosurgical Anatomy

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Li, P., Shen, Y., Xu, J. et al. Contralateral cervical seventh nerve transfer for spastic arm paralysis via a modified prespinal route: a cadaveric study. Acta Neurochir 162, 141–146 (2020). https://doi.org/10.1007/s00701-019-04069-y

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  • DOI: https://doi.org/10.1007/s00701-019-04069-y

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