Optimizing nerve transfer surgery in tetraplegia: clinical decision making based on innervation patterns in spinal cord injury

OBJECTIVE Nerve transfers are increasingly being utilized in the treatment of chronic tetraplegia, with increasing literature describing significant improvements in sensorimotor function up to years after injury. However, despite technical advances, clinical outcomes remain heterogenous. Preoperative electrodiagnostic testing is the most direct measure of nerve health and may provide prognostic information that can optimize preoperative patient selection. The objective of this study in patients with spinal cord injury (SCI) was to determine various zones of injury (ZOIs) via electrodiagnostic assessment (EDX) to predict motor outcomes after nerve transfers in tetraplegia. METHODS This retrospective review of prospectively collected data included all patients with tetraplegia from cervical SCI who underwent nerve transfer at the authors’ institution between 2013 and 2020. Preoperative demographic data, results of EDX, operative details, and postoperative motor outcomes were extracted. EDX was standardized into grades that describe donor and recipient nerves. Five zones of SCI were defined. Motor outcomes were then compared based on various zones of innervation. RESULTS Nineteen tetraplegic patients were identified who underwent 52 nerve transfers targeting hand function, and 75% of these nerve transfers were performed more than 1 year postinjury, with a median interval to surgery following SCI of 24 (range 8–142) months. Normal recipient compound muscle action potential and isolated upper motor neuron injury on electromyography (EMG) were associated with greater motor recovery. When nerve transfers were stratified based on donor EMG, greater motor gains were associated with normal than with abnormal donor EMG motor unit recruitment patterns. When nerve transfers were separated based on donor and recipient nerves, normal flexor donors were more crucial than normal extensor donors in powering their respective flexor recipients. CONCLUSIONS This study elucidates the relationship of the preoperative innervation zones in SCI patients to final motor outcomes. EDX studies can be used to tailor surgical therapies for nerve transfers in patients with tetraplegia. The authors propose an algorithm for optimizing nerve transfer strategies in tetraplegia, whereby understanding the ZOI and grade of the donor/recipient nerve is critical to predicting motor outcomes.

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Nerve Transfer Surgery in Spinal Cord Injury: Online Information Sharing

10.21203/rs.3.rs-240706/v1 ◽

2021 ◽

Author(s):

Syena Moltaji ◽

Christine B Novak ◽

Jana Dengler

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Information Sharing ◽

Personal Experience ◽

Medical Information ◽

Cervical Spinal Cord ◽

Nerve Transfer ◽

Objective Information ◽

Nerve Transfers ◽

Cord Injury

Abstract BackgroundNerve transfer to improve upper extremity function in persons with cervical spinal cord injury (SCI) is a new reconstructive option, and has led to more people seeking and sharing surgical information and experiences. This study evaluated the role of social media in information-sharing on nerve transfer surgery within the SCI community.MethodsData were collected from Facebook, which is the favored information-sharing platform among individuals seeking medical information. Searched terms included ‘spinal cord injury’ and ‘SCI’ and excluded groups with: less than two members (n = 7); closed groups (n = 2); not pertaining to SCI (n = 13); restricted access (n = 36); and non-English (n = 2). Within public and private accessed groups, searches were conducted for ‘nerve’, ‘transfer’, ‘nerve transfer’, and ‘nerve surgery’. Each post about nerve transfer, responses to posts, and comments about nerve transfer in response to unrelated posts were tabulated. Thematic content analyses were performed and data were categorized as seeking information, sharing information, sharing support, and sharing appreciation.ResultsThe search yielded 99 groups; 35 met the inclusion criteria (average size = 2,007, largest = 12,277). Nerve transfer was discussed in nine groups, with 577 total mentions. In the seeking information axis, posts were related to personal experience (54%), objective information (31%), surgeon/center performing the procedure (9%), and second opinion (4%). At least 13% of posts were from individuals learning about nerve transfers for the first time. In the sharing information axis, the posts: shared personal experience (52%); shared objective information (13%); described alternative treatment (3%); tagged someone to share information (11%); linked to outside resources (12%); and recommended a specific surgeon/center (9%).ConclusionSocial media is an important source of information and support for people with SCI. There is a paucity of information on nerve transfers. These study findings will inform implementation of future education strategies.

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Nerve Transfer Strategies for Spinal Cord Injury

World Neurosurgery ◽

10.1016/j.wneu.2012.10.001 ◽

2013 ◽

Vol 80 (6) ◽

pp. e319-e326 ◽

Cited By ~ 27

Author(s):

Ferry Senjaya ◽

Rajiv Midha

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Nerve Transfer ◽

Cord Injury ◽

Transfer Strategies

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Nerve transfer surgery in spinal cord injury: online information sharing

BMC Neurology ◽

10.1186/s12883-021-02209-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Syena Moltaji ◽

Christine B. Novak ◽

Jana Dengler

Keyword(s):

Spinal Cord ◽

Social Media ◽

Spinal Cord Injury ◽

Information Sharing ◽

Personal Experience ◽

Medical Information ◽

Nerve Transfer ◽

Objective Information ◽

Nerve Transfers ◽

Cord Injury

Abstract Background Nerve transfer to improve upper extremity function in persons with cervical spinal cord injury (SCI) is a new reconstructive option, and has led to more people seeking and sharing surgical information and experiences. This study evaluated the role of social media in information-sharing on nerve transfer surgery within the SCI community. Methods Data were collected from Facebook, which is the favored information-sharing platform among individuals seeking medical information. Searched terms included ‘spinal cord injury’ and ‘SCI’ and excluded groups with: less than two members (n = 7); closed groups (n = 2); not pertaining to SCI (n = 13); restricted access (n = 36); and non-English (n = 2). Within public and private accessed groups, searches were conducted for ‘nerve’, ‘transfer’, ‘nerve transfer’, and ‘nerve surgery’. Each post about nerve transfer, responses to posts, and comments about nerve transfer in response to unrelated posts were tabulated. Thematic content analyses were performed and data were categorized as seeking information, sharing information, sharing support, and sharing appreciation. Results The search yielded 99 groups; 35 met the inclusion criteria (average size = 2007, largest = 12,277). Nerve transfer was discussed in nine groups, with 577 total mentions. In the seeking information axis, posts were related to personal experience (54%), objective information (31%), surgeon/center performing the procedure (9%), and second opinion (4%). At least 13% of posts were from individuals learning about nerve transfers for the first time. In the sharing information axis, the posts: shared personal experience (52%); shared objective information (13%); described alternative treatment (3%); tagged someone to share information (11%); linked to outside resources (12%); and recommended a specific surgeon/center (9%). Conclusion Social media is an important source of information and support for people with SCI. There is a paucity of information on nerve transfers. These study findings will inform implementation of future education strategies.

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Nerve Transfer for Restoring Upper Limb Function in Traumatic Cervical Spinal Cord Injury

Hand ◽

10.1177/1558944716660555fd ◽

2016 ◽

Vol 11 (1_suppl) ◽

pp. 84S-85S

Author(s):

Joseph Ward ◽

Mohammad Nassimizadeh ◽

Simon Tan ◽

Dominic Power

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Upper Limb ◽

Cervical Spinal Cord ◽

Nerve Transfer ◽

Cervical Spinal Cord Injury ◽

Limb Function ◽

Upper Limb Function ◽

Cord Injury

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Reducing Neuron Apoptosis in the Pontine Micturition Center by Nerve Root Transfer for Restoration of Micturition Function after Spinal Cord Injury

BioMed Research International ◽

10.1155/2020/5615097 ◽

2020 ◽

Vol 2020 ◽

pp. 1-9

Author(s):

Ronghua Yu ◽

Gang Yin ◽

Jianguo Zhao ◽

Huihao Chen ◽

Depeng Meng ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Nerve Root ◽

Neuronal Apoptosis ◽

Nerve Transfer ◽

Tunel Staining ◽

Nerve Roots ◽

Cord Injury ◽

Group A ◽

Group B

Objective. The rate of neuronal apoptosis increases after spinal cord injury (SCI). Anastomosing the normal nerve roots above the SCI level to the injured sacral nerve roots can enhance the functional recovery of neurons. Therefore, we evaluated the effect of sacral nerve root transfer after SCI on pontine neuronal survival. Methods. Sprague–Dawley rats were randomly divided into three groups: Group A, reconstruction of afferent and efferent nerve pathways of the bladder after SCI; Group B, SCI only; and Group C, control group. We examined pontine neuronal morphology using hematoxylin and eosin (H&E) staining after SCI and nerve transfer. Bcl-2 and Bax protein expression changes in the pontine micturition center were quantified by immunohistochemistry. The number of apoptotic neurons was determined by TUNEL staining. We examined pontine neuronal apoptosis by transmission electron microscopy (TEM) at different time points. Results. H&E staining demonstrated that the number of neurons had increased in Group A, but more cells in Group B displayed nuclear pyknosis, with the disappearance of the nucleus. Compared with Group B, Group A had significantly higher Bcl-2 expression, significantly lower Bax expression, and a significantly higher Bcl-2/Bax ratio. The number of apoptotic neurons and neuron bodies in Group A was significantly lower than that in Group B, as indicated by TUNEL staining and TEM. Conclusions. These findings demonstrate that lumbosacral nerve transfer can reduce neuronal apoptosis in the pontine micturition center and enhance functional recovery of neurons. This result further suggests that lumbosacral nerve transfer can be used as a new approach for reconstructing bladder function after spinal cord injury.

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Intercostal, ilioinguinal, and iliohypogastric nerve transfers for lower limb reinnervation after spinal cord injury: an anatomical feasibility and experimental study

Journal of Neurosurgery Spine ◽

10.3171/2018.8.spine181 ◽

2019 ◽

Vol 30 (2) ◽

pp. 268-278 ◽

Cited By ~ 1

Author(s):

Ahmed A. Toreih ◽

Asser A. Sallam ◽

Cherif M. Ibrahim ◽

Ahmed I. Maaty ◽

Mohsen M. Hassan

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Animal Studies ◽

Femoral Nerve ◽

Lower Limbs ◽

Nerve Transfers ◽

Promising Therapeutic Approach ◽

Cord Injury ◽

Significant Motor

OBJECTIVESpinal cord injury (SCI) has been investigated in various animal studies. One promising therapeutic approach involves the transfer of peripheral nerves originating above the level of injury into those originating below the level of injury. The purpose of the present study was to evaluate the feasibility of nerve transfers for reinnervation of lower limbs in patients suffering SCI to restore some hip and knee functions, enabling them to independently stand or even step forward with assistive devices and thus improve their quality of life.METHODSThe feasibility of transferring intercostal to gluteal nerves and the ilioinguinal and iliohypogastric nerves to femoral nerves was assessed in 5 cadavers. Then, lumbar cord hemitransection was performed below L1 in 20 dogs, followed by transfer of the 10th, 11th, and 12th intercostal and subcostal nerves to gluteal nerves and the ilioinguinal and iliohypogastric nerves to the femoral nerve in only 10 dogs (NT group). At 6 months, clinical and electrophysiological evaluations of the recipient nerves and their motor targets were performed.RESULTSThe donor nerves had sufficient length to reach the recipient nerves in a tension-free manner. At 6 months postoperatively, the mean conduction velocity of gluteal and femoral nerves, respectively, increased to 96.1% and 92.8% of the velocity in controls, and there was significant motor recovery of the quadriceps femoris and glutei.CONCLUSIONSIntercostal, ilioinguinal, and iliohypogastric nerves are suitable donors to transfer to the gluteal and femoral nerves after SCI to restore some hip and knee motor functions.

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Nerve transfer surgery in cervical spinal cord injury: a qualitative study exploring surgical and caregiver participant experiences

Disability and Rehabilitation ◽

10.1080/09638288.2019.1669225 ◽

2019 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Ida Fox ◽

Gwendolyn Hoben ◽

Goldie Komaie ◽

Christine Novak ◽

Rebecca Hamm ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Qualitative Study ◽

Cervical Spinal Cord ◽

Nerve Transfer ◽

Cervical Spinal Cord Injury ◽

Cord Injury

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Nerve Transfers to Restore Upper Extremity Function in Cervical Spinal Cord Injury

Plastic & Reconstructive Surgery ◽

10.1097/prs.0000000000001641 ◽

2015 ◽

Vol 136 (4) ◽

pp. 780-792 ◽

Cited By ~ 34

Author(s):

Ida K. Fox ◽

Kristen M. Davidge ◽

Christine B. Novak ◽

Gwendolyn Hoben ◽

Lorna C. Kahn ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Upper Extremity ◽

Cervical Spinal Cord ◽

Cervical Spinal Cord Injury ◽

Nerve Transfers ◽

Extremity Function ◽

Cord Injury ◽

Upper Extremity Function

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Nerve transfers for the restoration of hand function after spinal cord injury

Journal of Neurosurgery ◽

10.3171/2012.3.jns12328 ◽

2012 ◽

Vol 117 (1) ◽

pp. 176-185 ◽

Cited By ~ 47

Author(s):

Susan E. Mackinnon ◽

Andrew Yee ◽

Wilson Z. Ray

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Single Case ◽

Motor Nerve ◽

Hand Function ◽

Public Health Problem ◽

Nerve Transfers ◽

Cord Injury ◽

Significant Public Health Problem ◽

Significant Public Health

Spinal cord injury (SCI) remains a significant public health problem. Despite advances in understanding of the pathophysiological processes of acute and chronic SCI, corresponding advances in translational applications have lagged behind. Nerve transfers using an expendable nearby motor nerve to reinnervate a denervated nerve have resulted in more rapid and improved functional recovery than traditional nerve graft reconstructions following a peripheral nerve injury. The authors present a single case of restoration of some hand function following a complete cervical SCI utilizing nerve transfers.

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