Nerve and Tendon Transfer Surgery in Cervical Spinal Cord Injury: Individualized Choices to Optimize Function

• Published in: Topics in spinal cord injury rehabilitation Vol. 24; no. 3; pp. 275 - 287
• Main Authors: Fox, Ida K, Miller, Amanda K, Curtin, Catherine M
• Format: Journal Article
• Language: English
• Published: United States Allen Press Inc 01.06.2018; Thomas Land Publishers, Inc
• Subjects: Humans; Nerve Transfer - methods; Original; Ostomy; Patients; Physical therapy; Physiology; Recovery of Function - physiology; Rehabilitation; Spasticity; Spinal cord injuries; Spinal Cord Injuries - physiopathology; Spinal Cord Injuries - surgery; Surgery; Tendon Transfer - methods; Topography; Upper Extremity - physiopathology; spinal cord injury; tendon transfer; nerve transfer; upper extremity; tetraplegia
• ISSN: 1082-0744; 1945-5763
• DOI: 10.1310/sci2403-275

Recent adaption of nerve transfer surgery to improve upper extremity function in cervical spinal cord injury (SCI) is an exciting development. Tendon transfer procedures are well established, reliable, and can significantly improve function. Despite this, few eligible surgical candidates in the United States undergo these restorative surgeries. The literature on these procedures was reviewed. Options to improve function include surgery to restore elbow extension, wrist extension, and hand opening and closing function. Tendon transfers are reliable and well tolerated but require weeks of immobilization and limits on extremity use. The role of nerve transfers is still being established. Early results indicate variable return of meaningful function with less immobilization but longer periods (up to years) required to gain appreciable function. Nerve and tendon transfer surgery sacrifice an expendable donor to restore a missing and more critical function. These procedures are well described in hand surgery; are reliable, well tolerated, and covered by insurance; and should be part of the SCI rehabilitation discussion.