Nerve transfer surgery restores hand and arm movement in patients with quadriplegia

Surgeons reported outcomes of 13 nerve transfer operations in 9 quadriplegic patients with cervical spinal cord injuries. Every patient in the study had improved hand and arm function.

In nerve transfer surgery, the surgeon takes a healthy donor nerve from above the injury site, usually in the shoulders or elbows, and connects it to a paralyzed nerve in the hand or arm, bypassing the damaged spinal cord area.

Because the procedure involves cutting and reattaching peripheral nerves, the nerves need time to reinnervate and the brain needs time to relearn how to use the muscle. Individual patient outcomes are subtle and variable, and can take months to a year to measure. But they can dramatically improve function and independence.

“Physically, nerve transfer surgery provides incremental improvements in hand and arm function. However, psychologically, these small steps are huge for a patient’s quality of life,” said the study’s lead author, Ida K. Fox, MD, assistant professor of plastic and reconstructive surgery at Washington University School of Medicine in St. Louis, MO. “One of my patients told me he was able to pick up a noodle off his chest when he dropped it. Before the surgery, he couldn’t move his fingers. It meant a lot for him to clean off that noodle without anyone helping him.”

The researchers published their case series in the October issue of Plastic and Reconstructive Surgery.

Ultimately, researchers hope one day to restore full movement to the estimated 250,000 Americans living with spinal cord injuries—more than half of which are at the cervical level. But until that day, patients appreciate regaining basic independence in routine tasks.

“Hand function is instrumental to basic activities of daily living and critically influences level of independence in spinal cord injury,” the researchers wrote in their study. “Mid to lower level cervical spinal cord injury patients have shoulder and elbow function but no volitional hand function. These patients have specifically stated that hand function is more important than activities such as walking and sexual performance.”

In 2012, Michael D. Bavlsik, MD, a primary care physician, suffered a cervical spinal cord injury from an auto accident. The nerve transfer procedure allowed Dr. Bavlsik to feed himself with a fork, write with a pen, look into his patients’ ears with an otoscope, and drive his kids to activities.

“Nerve transfer surgery has been very successful in helping me because it restored triceps function and improvement in my grip,” said Dr. Bavlsik, an assistant professor of clinical medicine at Washington University School of Medicine. “I am extremely grateful for this surgery,” he said.

“The gains after nerve transfer surgery are not instantaneous,” said the study’s senior author, Susan E. Mackinnon, MD, director of the Division of Plastic and Reconstructive Surgery at the School of Medicine, and the surgeon who pioneered nerve transfer surgery about 25 years ago at Washington University School of Medicine. “But once established, the surgery’s benefits provide a way to let individuals with spinal cord injuries improve their daily lives.”

The authors concluded, “Further work to increase awareness of these operations, especially for early intervention in the case of rescue transfers … is needed. By collaboration with our colleagues in trauma, orthopedic/neurosurgery, physical and rehabilitation medicine, and therapy (physical, occupational, and hand), among others, we can jointly improve our care of patients with cervical spinal cord injury.”