107 Nerve Transfers in Spinal Cord Injury: Analysis of Factors Influencing Motor Recovery. (April 2023)
- Record Type:
- Journal Article
- Title:
- 107 Nerve Transfers in Spinal Cord Injury: Analysis of Factors Influencing Motor Recovery. (April 2023)
- Main Title:
- 107 Nerve Transfers in Spinal Cord Injury: Analysis of Factors Influencing Motor Recovery
- Authors:
- Javeed, Saad
Dibble, Christopher
Greenberg, Jacob K.
Zhang, Justin
Khalifeh, Jawad M.
Ray, Zack - Abstract:
- Abstract : INTRODUCTION: Nerve transfers have the potential to reanimate lost upper limb function following cervical spinal cord injury (SCI). However, the factors influencing motor recovery following nerve transfers in cervical SCI remains unknown. METHODS: A prospective cohort of cervical SCI patients 18 years of age with American Spinal Injury Association [ASIA] grade A-C underwent nerve transfers and followed-up until 48-months. Preoperative variables included age, time-delay post-SCI, neurological level-of-injury, ASIA grades, international classification of surgery of hand in tetraplegia (ICSHT) indicating preserved upper limb function, and recipient-nerve-electrodiagnosis. Univariate analyses were performed followed by multivariable proportional-odds logistic-regression of significant predictors. The primary outcome was motor recovery in medical research council (MRC) grades categorized as: poor-recovery (MRC grades 0-2); good-recovery (grade 3); and excellent-recovery (grades 4-5). The ICSHT was categorized into very-high-level (ICSHT-0; absent-function); high-level (ICSHT 1-2; intact biceps/brachioradialis); and low-level-injury (ICSHT 3-4; intact wrist-extension/pronation). RESULTS: 21 cervical SCI patients underwent 57 nerve transfers (33 upper limbs) at median of 21 (range: 6-142) months post-SCI. At final follow-up, median-gain in triceps MRC was: 3 ([IQR] 2.5-4, p = 0.011), finger-extensors: 4 (2-4, p < 0.001), and finger-flexors: 2 (1-3, p < 0.001). OnAbstract : INTRODUCTION: Nerve transfers have the potential to reanimate lost upper limb function following cervical spinal cord injury (SCI). However, the factors influencing motor recovery following nerve transfers in cervical SCI remains unknown. METHODS: A prospective cohort of cervical SCI patients 18 years of age with American Spinal Injury Association [ASIA] grade A-C underwent nerve transfers and followed-up until 48-months. Preoperative variables included age, time-delay post-SCI, neurological level-of-injury, ASIA grades, international classification of surgery of hand in tetraplegia (ICSHT) indicating preserved upper limb function, and recipient-nerve-electrodiagnosis. Univariate analyses were performed followed by multivariable proportional-odds logistic-regression of significant predictors. The primary outcome was motor recovery in medical research council (MRC) grades categorized as: poor-recovery (MRC grades 0-2); good-recovery (grade 3); and excellent-recovery (grades 4-5). The ICSHT was categorized into very-high-level (ICSHT-0; absent-function); high-level (ICSHT 1-2; intact biceps/brachioradialis); and low-level-injury (ICSHT 3-4; intact wrist-extension/pronation). RESULTS: 21 cervical SCI patients underwent 57 nerve transfers (33 upper limbs) at median of 21 (range: 6-142) months post-SCI. At final follow-up, median-gain in triceps MRC was: 3 ([IQR] 2.5-4, p = 0.011), finger-extensors: 4 (2-4, p < 0.001), and finger-flexors: 2 (1-3, p < 0.001). On univariate analysis, age, time-delay post-SCI, and ICSHT were significantly associated with motor recovery. On multivariable analysis, the low-level-injury (ICSHT 3-4) was significantly associated with superior motor outcomes as compared to higher-level injuries (Odds ratio [OR] 12.2, 95% CI, 2.34-91.4; p = 0.005). Each month delay increased 5% odds of superior motor function (OR 1.05, 95% CI, 1.01-1.11; p = 0.03). CONCLUSIONS: The preserved motor function in upper limb (ICSHT-grouping) significantly predicts motor outcomes following nerve transfers in cervical SCI. Nerve transfers in chronic SCI (12 months) results in comparable motor outcomes to earlier reinnervation. … (more)
- Is Part Of:
- Neurosurgery. Volume 69(2023)Supplement 1
- Journal:
- Neurosurgery
- Issue:
- Volume 69(2023)Supplement 1
- Issue Display:
- Volume 69, Issue 1 (2023)
- Year:
- 2023
- Volume:
- 69
- Issue:
- 1
- Issue Sort Value:
- 2023-0069-0001-0000
- Page Start:
- 24
- Page End:
- 24
- Publication Date:
- 2023-04
- Subjects:
- Nervous system -- Surgery -- Periodicals
617.48005 - Journal URLs:
- https://academic.oup.com/neurosurgery ↗
http://www.neurosurgery-online.com ↗
https://journals.lww.com/neurosurgery/pages/default.aspx ↗
http://journals.lww.com ↗ - DOI:
- 10.1227/neu.0000000000002375_107 ↗
- Languages:
- English
- ISSNs:
- 0148-396X
- Deposit Type:
- Legaldeposit
- View Content:
- Available online (eLD content is only available in our Reading Rooms) ↗
- Physical Locations:
- British Library DSC - 6081.582000
British Library DSC - BLDSS-3PM
British Library STI - ELD Digital store - Ingest File:
- 26179.xml