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The Use of Nerve Transfers to Restore Upper Extremity Function in Cervical Spinal Cord Injury
Author(s) -
Fox Ida K.,
Novak Christine B.,
Krauss Emily M.,
Hoben Gwendolyn M.,
Zaidman Craig M.,
Ruvinskaya Rimma,
Juknis Neringa,
Winter Anke C.,
Mackin Susan E.
Publication year - 2018
Publication title -
pmandr
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.617
H-Index - 66
eISSN - 1934-1563
pISSN - 1934-1482
DOI - 10.1016/j.pmrj.2018.03.013
Subject(s) - medicine , spinal cord injury , retrospective cohort study , rehabilitation , surgery , tetraplegia , nerve injury , medical record , elbow , physical therapy , physical medicine and rehabilitation , spinal cord , psychiatry
Background Nerve transfer surgery to restore upper extremity function in cervical spinal cord injury (SCI) is novel and may transform treatment. Determining candidacy even years post‐SCI is ill defined and deserves investigation. Objective To develop a diagnostic algorithm, focusing on electrodiagnostic (EDX) studies, to determine eligibility for nerve transfer surgery. Design Retrospective descriptive case series. Setting Tertiary university‐based institution. Patients Individuals with cervical SCI (n = 45). Methods The electronic medical records of people referred to the Plastic Surgery Multidisciplinary Upper Extremity Surgery in SCI clinic from 2010‐2015 were reviewed. People were considered for nerve transfers to restore elbow extension or finger flexion and/or extension. Data including demographic, clinical evaluation, EDX results, surgery, and outcomes were collected and analyzed. Main Outcome Measurements EDX data, including nerve conduction studies and electromyography, for bilateral upper extremities of each patient examined was used to assess for the presence of lower motor neuron injury, which would preclude late nerve transfer. Results Based on our criteria and the results of EDX testing, a substantial number of patients presenting even years post‐SCI were candidates for nerve transfers. Clinical outcome results are heterogeneous but promising and suggest that further refinement of eligibility, long‐term follow‐up, and standardized assessment will improve our understanding of the role of nerve transfer surgery to restore function in people with midcervical SCI. Conclusions Many patients living with SCI are candidates for nerve transfer surgery to restore upper extremity function. Although the ultimate efficacy of these surgeries is not yet determined, this study attempts to report the criteria we are using and may ultimately determine the timing for intervention and which transfers are most useful for this heterogeneous population. Level of Evidence IV