Contralateral C7 nerve transfer through posterior vertebral approach combined with selective posterior rhizotomy of the affected cervical nerve in the treatment of central upper limb spastic paralysis

Abstract Background: The previous investigation regarding contralateral seventh cervical nerve transfer (CC7) revealed a novel and effective approach to improve arm function in patients with chronic spastic paralysis. The patients who underwent both CC7 and standard rehabilitation showed greater functional improvements and spasticity reductions than did the control group who underwent rehabilitation only. Additional efforts are needed to maximize the benefits in patients and establishing a supporting nursing program is a promising way of achieving this goal.Methods: The present Huashan nursing program was established in consideration of the following elements, that were the routine perioperative care, ensuring surgical safety and improving patient cooperation. Before surgery, psychiatric nursing, health education and risk control were stressed. After surgery, in addition to routine nursing and positioning, special attention was needed for the targeted nursing of postoperative adverse events. In addition, we performed descriptive statistical analysis on the clinical data of patients receiving the Huashan nursing program, focusing on postoperative adverse events. Totally 85 patients were included in the study, and postoperative adverse events occurred in 10 patients, including severe pain (5, 5.88%), neck hematoma (2, 2.35%), dyspnea (2, 2.35%) and hoarseness (1, 1.18%). The above adverse events were alleviated under the targeted nursing guided by the Huashan program.Discussion: This article introduces the Huashan nursing program, which is based on preoperative evaluations, educational sessions, postoperative monitoring and targeted nursing, for patients undergoing CC7. The present nursing program helped the promotion and provided the opportunity to maximize the benefits of CC7.

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Contralateral C7 nerve transfer via the prespinal route in treatment of spastic paralysis of upper limb after cerebral palsy

British Journal of Neurosurgery ◽

10.1080/02688697.2020.1859091 ◽

2020 ◽

pp. 1-5

Author(s):

Xiaoyun Pan ◽

Gang Zhao ◽

Xiaojiao Yang ◽

Yong Hua ◽

Jun Wang ◽

...

Keyword(s):

Cerebral Palsy ◽

Upper Limb ◽

Nerve Transfer ◽

Spastic Paralysis

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Improved white matter integrity after contralateral seventh cervical nerve transfer measured by tractographic representation

Clinical Neurology and Neurosurgery ◽

10.1016/j.clineuro.2021.106715 ◽

2021 ◽

pp. 106715

Author(s):

Hyun-Joo Lee ◽

Hyun-Sil Cha ◽

Myong-Hun Hahm ◽

Huijoong Lee ◽

Sang Soo Kim ◽

...

Keyword(s):

White Matter ◽

Nerve Transfer ◽

White Matter Integrity ◽

Cervical Nerve

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Clinical Application of Scalp Cluster Needling Combined with Bobath Technique in Upper Limb Spastic Paralysis After Stroke of Vertebral Artery Type

Acupuncture & Electro-Therapeutics Research ◽

10.3727/036012921x16287835103417 ◽

2021 ◽

Author(s):

Aimin Gong ◽

Mengjie Zeng ◽

Zhiquan Wu

Keyword(s):

Treatment Group ◽

Acupuncture Therapy ◽

Vertebral Artery ◽

Upper Limb ◽

Training Group ◽

Control Group ◽

Upper Limbs ◽

Spastic Paralysis ◽

Rehabilitation Training ◽

The Difference

To observe the difference in clinical effects of scalp-point cluster acupuncture combined with rehabilitation training in treating spastic paralysis of upper limbs after stroke. Using a randomized controlled design, 96 patients with upper limb spastic paralysis after stroke were randomly divided into two groups: treatment group (scalp acupuncture plus rehabilitation training group 48 cases), control group (rehabilitation training group 48 cases). After 2 courses of treatment, it was judged by observing clinical efficacy evaluation, Ashworth classification, and Fugl-Meyer (FMA) score. The total effective rate was 91.7% in the treatment group and 68.7% in the control group; the difference between the two groups was statistically significant (P <0.05). Before treatment, the difference in Ashworth classification between the two groups was not statistically significant (P> 0.05); after treatment, the difference between the two groups was statistically significant (P <0.01). After treatment, the difference between the two groups was statistically significant (P＜0.05). The Fugl-Meyer (FMA) scores of the two groups of patients before treatment were comparable (P>0.05), and there were significant differences between the two groups after treatment (P <0.05). The difference of Fugl-Meyer (FMA) scores between the two groups was statistically significant (P < 0.01). Scalp cluster acupuncture therapy is more effective than traditional acupuncture therapy alone in treating vertebral artery type cervical spondylosis. Scalp cluster acupuncture combined with Bobath technique is effective in treating spastic paralysis of upper limbs after stroke, and it is worthy of clinical application.

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A novel method of lengthening the accessory nerve for direct coaptation during nerve repair and nerve transfer procedures

Journal of Neurosurgery ◽

10.3171/2016.10.jns161106 ◽

2018 ◽

Vol 128 (1) ◽

pp. 272-276

Author(s):

R. Shane Tubbs ◽

Andrés A. Maldonado ◽

Yolanda Stoves ◽

Fabian N. Fries ◽

Rong Li ◽

...

Keyword(s):

Nerve Repair ◽

Nerve Transfer ◽

Nerve Fibers ◽

Accessory Nerve ◽

Cervical Nerve ◽

Neural Connections ◽

Direct Repair ◽

Novel Method ◽

Time Distance ◽

Transfer Procedures

OBJECTIVEThe accessory nerve is frequently repaired or used for nerve transfer. The length of accessory nerve available is often insufficient or marginal (under tension) for allowing direct coaptation during nerve repair or nerve transfer (neurotization), necessitating an interpositional graft. An attractive maneuver would facilitate lengthening of the accessory nerve for direct coaptation. The aim of the present study was to identify an anatomical method for such lengthening.METHODSIn 20 adult cadavers, the C-2 or C-3 connections to the accessory nerve were identified medial to the sternocleidomastoid (SCM) muscle and the anatomy of the accessory nerve/cervical nerve fibers within the SCM was documented. The cervical nerve connections were cut. Lengths of the accessory nerve were measured. Samples of the cut C-2 and C-3 nerves were examined using immunohistochemistry.RESULTSThe anatomy and adjacent neural connections within the SCM are complicated. However, after the accessory nerve was “detethered” from within the SCM and following transection, the additional length of the accessory nerve increased from a mean of 6 cm to a mean of 10.5 cm (increase of 4.5 cm) after cutting the C-2 connections, and from a mean of 6 cm to a mean length of 9 cm (increase of 3.5 cm) after cutting the C-3 connections. The additional length of accessory nerve even allowed direct repair of an infraclavicular target (i.e., the proximal musculocutaneous nerve). The cervical nerve connections were shown not to contain motor fibers.CONCLUSIONSAn additional length of the accessory nerve made available in the posterior cervical triangle can facilitate direct repair or neurotization procedures, thus eliminating the need for an interpositional nerve graft, decreasing the time/distance for regeneration and potentially improving clinical outcomes.

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