login
  Password reminder
NeuroNews
Contact the editor Visit NeuroNews Twitter feed Visit NeuroNews Facebook page
 

Nerve transfers help to restore some hand function in quadriplegic patient


Thursday, 17 May 2012 13:22
Susan Mackinnon
Susan Mackinnon


Susan E Mackinnon (Washington University School of Medicine, St Louis, USA) and colleagues have reported the first case of restoration of some hand function (finger and thumb flexion) in a quadriplegic patient utilising nerve transfers after cervical spinal cord injury. The case was published on 15 May in the online edition of the Journal of Neurosurgery.  

 


Instead of operating on the spine itself, the surgeons rerouted working nerves in the upper arms. “The use of nerve transfers has gained significant momentum over the last decade and has changed the treatment algorithm in patients with nerve injuries,” Mackinnon et al wrote.

The patient is a 71-year-old man who presented spinal cord injury in the C7 level. Twenty-three months after the injury — caused in a car accident — the patient underwent bilateral transfer of the brachialis nerve (C6 level) to the anterior interosseouss nerve (AIN) (C8 level). “Surgery was performed initially on the patient’s left side and was followed one week later by surgery on the right,” the authors reported.


According to the authors, “this is the first reported case of thumb and finger flexor reinnervation after a spinal cord injury”.


“This procedure is unusual for treating quadriplegia because we do not attempt to go back into the spinal cord where the injury is,” said surgeon Ida K Fox, assistant professor of plastic and reconstructive surgery at Washington University, who treats patients at Barnes-Jewish Hospital (place where the surgery was performed). “Instead, we go out to where we know things work — in this case the elbow — so that we can borrow nerves there and reroute them to give hand function.”


After one year of intensive physical therapy, the patient regained some hand function, specifically the ability to bend the thumb and index finger. “He can now use his right hand to perform simple hand-to-mouth movements. With his left hand, he is able to feed himself and perform rudimentary writing activities,” Mackinnon et al reported.


“Our experience with this transfer in nerve injury suggests optimism for continued improvement for this patient over the next 3 years,” the authors wrote.


Mackinnon cautions that the hand function restored to the patient was not instantaneous and required intensive physical therapy. It takes time to retrain the brain to understand that nerves that used to bend the elbow now provide pinch, she said.


Though this study reports only one case, Mackinnon and colleagues do not anticipate a limited window of time during which a patient with a similar spinal cord injury must be treated with this nerve transfer technique. This patient underwent the surgery almost two years after his injury. As long as the nerve remains connected to the support and nourishment of the spinal cord, even though it no longer “talks” to the brain, the nerve and its associated muscle remain healthy, even years after the injury.


“This is not a particularly expensive or overly complex surgery,” Mackinnon said. “It is not a hand or a face transplant, for example. It is something we would like other surgeons around the country to do.”


“As Bertelli et al, have previously demonstrated, the use of nerver transfers may represent a significant breakthrough toward improved independent function in select patients with cervical spinal cord injuries.” Mackinnon et al concluded.




Add New Comment

Most popular


New device allows brain to bypass spinal cord and move paralysed limbs
Friday, 27 Jun 2014
For the first time ever, a paralysed man has moved his fingers and hand with his own thoughts after an electronic neural bypass for spinal cord injuries that reconnects the brain directly to muscles, ... New device allows brain to bypass spinal cord and move paralysed limbs

FDA IDE approval for PulseRider
Tuesday, 10 Jun 2014
The IDE allows Pulsar Vascular to begin a multicentre clinical trial in support of a humanitarian device exemption (HDE) to evaluate the PulseRider for US approval for wide neck aneurysms at or near ... FDA IDE approval for PulseRider

ROADSTER trial studying new path to carotid revascularisation completes patient enrolment
Friday, 18 Jul 2014
The trial was the first of its kind to study the treatment of carotid artery stenosis by placing a stent via direct access to the common carotid artery in the neck in an entirely new minimally ... ROADSTER trial studying new path to carotid revascularisation completes patient enrolment

Features


Neuro-oncologic treatment for glioblastoma
Monday, 21 Jul 2014
Malignant gliomas are the most common type of primary malignant brain tumour, accounting for 80% of patients and an annual incidence of 5.26 per 100,000 population, or 17,000 new cases diagnosed per ... Neuro-oncologic treatment for glioblastoma

Early brain stimulation may help stroke survivors recover language function
Monday, 21 Jul 2014
Dieter Heiss, who presented on early brain stimulation for stroke patients at the 8th World Congress on Controversies in Neurology (CONy), 8–11 May, Berlin, Germany, writes for NeuroNews on how this ... Early brain stimulation may help stroke survivors recover language function

Profiles


William T Couldwell
Thursday, 24 Apr 2014
William T Couldwell is professor of neurosurgery in the Department of Neurological Surgery, U... William T Couldwell

Ali R Rezai
Monday, 10 Feb 2014
Ali R Rezai speaks to NeuroNews about his clinical and research career, which has been focused on ... Ali R Rezai

Cardiac Rhythm News Vascular News Cardiovascular News Interventional News Spinal News NeuroNews
BIBA Medical BIBA MedTech Insights CX Symposium ilegx
 
Password Reminder

BIBA Medical, 526 Fulham Road, Fulham, London, SW6 5NR.
TEL: +44 (0)20 7736 8788 FAX: +44 (0)20 7736 8283 EMAIL: 
info@bibamedical.com
© BIBA Medical Ltd is a company registered in England and Wales with company number 2944429.
VAT registration number 730 6811 50.
Site Map | Terms and Conditions