Early Nerve Transfer Enables Hand Function After Spinal Cord Injury

Early nerve transfer surgery results in improvements in upper-limb function after spinal cord injury, according to a study published online in The Lancet.

Natasha van Zyl, M.B.B.S., from the Epworth Monash Rehabilitation Medicine Unit in Melbourne, Australia, and colleagues recruited people of any age with early cervical spinal cord injury of motor level C5 and below who had been referred for upper-extremity reanimation and were deemed suitable for nerve transfer. Sixteen participants with 27 limbs were included; among these patients, 59 transfers were done.

At 24 months, the researchers found significant improvements from baseline in median action research arm test total score (34.0 versus 16.5) and grasp release test total score (125.2 versus 35.0). There was improvement by more than the minimal detectable change and the minimal clinically important difference in the mean total spinal cord independence measure (SCIM) score and mobility in the room and toilet SCIM score. From baseline to 24 months, the mean self-care SCIM score improved by more than the minimal detectable change. After 24 months, the Median Medical Research Council strength grades were 3 and 4 for triceps and digital extensor muscles, respectively; mean grasp strength was 3.2 and 2.8 kg in those who underwent distal and proximal nerve transfers, respectively.

"It remains to be seen whether function and strength in muscles reanimated by nerve transfers continue to improve beyond 24 months postsurgery," the authors write.

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