Nerve transfer for upper extremity reanimation in people with spinal cord injury: A 2-year follow-up case series

Abstract

Objective

To describe the 2-year functional outcomes of nerve transfer (NT) for upper extremity reanimation.

Study Design

A prospective case series.

Setting

A highly specialized rehabilitation hospital for spinal cord injury (SCI) in Italy.

Intervention

Upper limb nerve transfer (32 NTs, 15 upper limbs).

Participants

Twelve male individuals with traumatic SCI (AIS A or B, neurological level from C4 to C7) were enrolled; 24-month follow-up data were available for 11.

Outcome measures

We evaluated the strength recovery of recipient muscles through the Medical Research Council (MRC) Scale for Muscle Strength. Upper limb function and independence were assessed with the Graded Redefined Assessment of Strength Sensibility and Prehension (GRASSP) test version 1 and the Spinal Cord Independent Measure III (SCIM III). Patient satisfaction was also evaluated.

Results

After 24 months, median MRC scores (range) were: triceps 2 (1–2); extensor digitorum communis 3 (1–4); extensor pollicis longus 2.5 (1–4); flexor digitorum profundus 2 (0–4); flexor pollicis longus 2 (0–4). No complication occurred. GRASSP prehension ability and prehension performance total scores significantly improved at 24 months from 1 (0–4) to 2 (0–7) and from 1 (0–8) to 5 (0–-22), respectively. The SCIM III self-care sub-scale score improved at 24-month follow-up (p = 0.009).

This study has important limitations, including a limited generalizability of the results and a small sample size that does not allow definitive conclusions to be drawn. A large multicenter prospective study is needed to confirm our findings.

Conclusions

NT represents a functional surgery option with few complications for the resuscitation of upper limbs in persons with tetraplegia.

Keywords:

• Spinal cord injury
• Nerve transfer
• Peripheral nerve surgery
• Rehabilitation

Acknowledgements

We wish to thank Dr Jacopo Bonavita for his valuable contribution to the realization of the work support in acquisition of data.

Disclaimer statements (main heading)

Contributors S.O. designed the study protocol, screened potentially eligible patients, conducted the study, collected data, was responsible for submitting the study to the ethical committee and took the lead in writing the manuscript. P.P. screened potentially eligible patients, conducted tests, collected data and contributed to the first draft of the manuscript. G.M. contributed to the screening of potentially eligible patients. C.K. supervised the research group and contributed to the final manuscript. E.M. performed the data analysis, interpreted the results and worked on the manuscript. J.V. contributed to the manuscript. C.S. contributed to the screening of potentially eligible patients and supervised the surgical content of the paper. All the authors provided critical feedback and approved the final version of the paper.

Funding No research grant was received for this study.

Declaration of interest Informed written consent to take part in the research has been obtained from all participants prior to the commencement of the study.

Conflicts of interest No potential conflict of interest was reported by the author(s).

Supplemental data

Supplemental data for this article can be accessed online at https://doi.org/10.1080/10790268.2024.2344313.