A new technique in which working nerves are rerouted to paralyzed sites in patients with spinal cord injury provides patients with significant functional improvement in upper limb and hand function and is being described as "a game changer."
A prospective case series of 16 patients undergoing this nerve transfer surgery at an Australian hospital has shown meaningful improvements in elbow extension and grasp-and-pinch hand functions.
In some cases, the nerve transfer surgery was successfully combined with tendon transfers to maximize functional benefits.
The current report — the largest prospective, consecutive case series of nerve transfers done at a single center in the tetraplegic population — was published online July 4 in The Lancet.
"Our results show that nerve transfer gives particularly good results for hand function. This includes grasping and pinching, and the open hand position needed for using a computer or smartphone. This gives patients a whole new realm of independence," lead author Natasha van Zyl, MBBS, Austin Health, Melbourne, Australia, told Medscape Medical News.
"The improvements in hand function we have achieved with nerve transfer have allowed patients to do their own personal care, handle money, feed themselves with normal utensils, hold a cup or glass and drink independently, and go to the toilet themselves. The ability to use their hands for functions like this is what spinal cord injury patients want most — more so than being able to walk," she added.
"Expendable" Nerves
Van Zyl explained that the procedure involves taking a nerve that is working but is expendable (it is supplying a muscle that is also supported by other working nerves) and rerouting it to a muscle that is paralyzed.
"Many spinal cord injury patients still have the ability to move their shoulders, bend their elbows and expand their wrists — this means we have the nerves to these muscles at our disposal," she said.
"It's like unplugging the power source to the toaster and plugging it into the kettle instead."
She explained that nerve transfer is not a new concept. "We have been doing this for peripheral nerve and brachial plexus injuries for many years, but its use in spinal cord injury only started recently, and before this publication there have only been single cases reported."
Van Zyl has been pioneer in this area.
"I was doing a lot of brachial plexus nerve transfer surgeries and I thought it might work in spinal cord injury so we started doing it and found good results.; Here we are reporting a case series with careful documentation of methodology and outcomes so that other surgeons can learn about the techniques that work best," she said.
