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

Top Spinal Cord Inj Rehabil, 2018 · DOI: 10.1310/sci2403-275 · Published: June 1, 2018

Simple Explanation

Nerve and tendon transfers involve sacrificing a functioning motor unit (the donor) to restore a more critical function lost due to cervical spinal cord injury (SCI). These surgeries aim to improve upper extremity function, which is a high priority for individuals with tetraplegia. Tendon transfer surgery involves detaching a muscle and its tendon and weaving it into a recipient tendon to restore function. Nerve transfer surgery involves cutting a nerve to a muscle and connecting it to a nonfunctioning nerve to restore its function. Recent advancements in timing, combinations of tendon transfer surgeries, neuroprosthetics, and nerve transfer techniques have made individualized approaches more relevant. This article provides an overview of these surgeries, including their history, physiology, and perioperative management.

Study Duration

Not specified

Participants

Not specified

Evidence Level

Not specified

Key Findings

1
Surgical options to improve function include surgery to restore elbow extension, wrist extension, and hand opening and closing function, catering to the specific needs of individuals with cervical SCI.
2
Tendon transfers are reliable and well-tolerated but require weeks of immobilization and limitations on extremity use during recovery, while nerve transfers offer variable return of function with less immobilization but longer recovery periods.
3
Nerve and tendon transfer surgeries are well-described in hand surgery, are reliable, well-tolerated, and covered by insurance, making them viable options for improving upper extremity function in individuals with cervical SCI.

Research Summary

Nerve and tendon transfer surgeries are valuable techniques for improving upper extremity function in individuals with cervical spinal cord injury (SCI). These procedures involve sacrificing a functioning motor unit (the donor) to restore a more critical function. Tendon transfers are reliable but require immobilization, while nerve transfers offer variable function return with less immobilization but longer recovery. The choice between nerve and tendon transfer depends on individual priorities and clinical findings. These established and well-tolerated treatments are covered by insurance and can provide gains in function for those with cervical SCI. These options should be discussed and made widely available even as concomitant efforts proceed to develop reliable neuroprosthetics and develop the cure.

Practical Implications

Individualized Surgical Planning

Tailoring surgical approaches based on the patient's specific injury pattern, functional deficits, and personal goals.

Preoperative Evaluation

Comprehensive assessment to ensure biological, psychological, and social stability, as well as determining candidacy for nerve or tendon transfer.

Postoperative Rehabilitation

Implementing targeted therapy and motor re-education programs to maximize functional gains and integrate new functions into daily activities.

Study Limitations

1
Variability in outcomes after nerve transfer surgery.
2
The need for more comparative work and information about the long-term outcome of nerve transfer.
3
Surgical intervention may not be suitable for all patients due to factors such as the extent of lower motor neuron involvement.

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