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.
Abbreviations used in this paper:AIN = anterior interosseous nerve; ASIA = American Spinal Injury Association; ICSHT = International Classification for Surgery of the Hand in Tetraplegia; MRC = Medical Research Council; SCI = spinal cord injury.
Address correspondence to: Wilson Z. Ray, M.D., Department of Neurological Surgery, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, Missouri 63110. email: email@example.com.
Please include this information when citing this paper: published online May 15, 2012; DOI: 10.3171/2012.3.JNS12328.
BertelliJATaccaCPGhizoniMFKechelePRSantosMA: Transfer of supinator motor branches to the posterior interosseous nerve to reconstruct thumb and finger extension in tetraplegia: case report. J Hand Surg Am35:1647–16512010
Guízar-SahagúnGRodríguez-BalderasCAFranco-BourlandREMartínez-CruzAGrijalvaIIbarraA: Lack of neuroprotection with pharmacological pretreatment in a paradigm for anticipated spinal cord lesions. Spinal Cord47:156–1602009
KumarPAHassanKM: Cross-face nerve graft with freemuscle transfer for reanimation of the paralyzed face: a comparative study of the single-stage and two-stage procedures. Plast Reconstr Surg109:451–4642002
LinHHouCZhenX: Bypassing spinal cord injury: surgical reconstruction of afferent and efferent pathways to the urinary bladder after conus medullaris injury in a rat model. J Reconstr Microsurg24:575–5812008
LouieGMackinnonSEDellonALPattersonGAHunterDA: Medial antebrachial cutaneous—lateral femoral cutaneous neurotization in restoration of sensation to pressure-bearing areas in a paraplegic: a four-year follow-up. Ann Plast Surg19:572–5761987
MackinnonSEDellonALPattersonGAGrussJS: Medial antebrachial cutaneous-lateral femoral cutaneous neurotization to provide sensation to pressure-bearing areas in the paraplegic patient. Ann Plast Surg14:541–5441985
MannCLeeJHLiuJStammersAMSohnHMTetzlaffW: Delayed treatment of spinal cord injury with erythropoietin or darbepoetin—a lack of neuroprotective efficacy in a contusion model of cord injury. Exp Neurol211:34–402008
National Spinal Cord Injury Statistical Center: Spinal Cord Injury Facts and Figures at a GlanceBirmingham, ALNSCISC2010. (https://www.nscisc.uab.edu/PublicDocuments/nscisc_home/pdf/Facts%20and%20Figures%20at%20a%20Glance%202010.pdf
OberlinCAmeurNETeboulFBeaulieuJYVacherC: Restoration of elbow flexion in brachial plexus injury by transfer of ulnar nerve fascicles to the nerve to the biceps muscle. Tech Hand Up Extrem Surg6:86–902002
OppenheimJSSpitzerDEWinfreeCJ: Spinal cord bypass surgery using peripheral nerve transfers: review of translational studies and a case report on its use following complete spinal cord injury in a human. Experimental article. Neurosurg Focus26:2E62009
SchwartzGFehlingsMG: Evaluation of the neuroprotective effects of sodium channel blockers after spinal cord injury: improved behavioral and neuroanatomical recovery with riluzole. J Neurosurg94:2 Suppl245–2562001
SönmezAKabakçiBVardarEGürelDSönmezUOrhanYT: Erythropoietin attenuates neuronal injury and potentiates the expression of pCREB in anterior horn after transient spinal cord ischemia in rats. Surg Neurol68:297–3032007
TadieMLiuSRobertRGuiheneucPPereonYPerrouin-VerbeB: Partial return of motor function in paralyzed legs after surgical bypass of the lesion site by nerve autografts three years after spinal cord injury. J Neurotrauma19:909–9162002
VialleRLozeronPLoureiroMCTadiéM: Multiple lumbar roots neurotizations with the lower intercostal nerves. Preliminary clinical and electrophysiological results in a sheep model. J Surg Res149:199–2052008
ZhangSJohnstonLZhangZMaYHuYWangJ: Restoration of stepping-forward and ambulatory function in patients with paraplegia: rerouting of vascularized intercostal nerves to lumbar nerve roots using selected interfascicular anastomosis. Surg Technol Int11:244–2482003